title: A pathway linking patient participation in cancer consultations to pain control.
abstract: OBJECTIVE
  To test a pathway through which a tailored, pain management education-coaching intervention could contribute to better cancer pain control through the effects of patients' communication about pain on physician prescribing of pain medication.
  
  
  METHODS
  Secondary analysis of data from a randomized controlled trial that tested the effects of a tailored education-coaching intervention on pain control for patients with advanced cancer. The current analysis focused on a subset of the patients (n = 135) who agreed to have their consultations audio-recorded. Patients' active communication about pain (e.g., expressing questions, concerns, and preferences about pain-related issues) was coded from audio-recordings. Change in pain medication was measured by patient self-report. Improvement in pain control was scored as the difference between baseline pain score and pain reported at 6 weeks.
  
  
  RESULTS
  Patients' pain-related communication was a significant predictor of patient-reported changes in physician prescribing of pain medication (p < .0001) and mediated the effect of baseline pain on medication change. Other predictors of change in pain medication were age (younger) and having participated in the intervention (as opposed to usual care). Of the patients reporting adjustment in pain medications, 49% experienced better pain control compared with only 27% of patients reporting no change in pain management (p < .02).
  
  
  CONCLUSIONS
  Cancer patients who ask questions, express concerns, and state preferences about pain-related matters can prompt physicians to change their pain management regimen, which in turn may lead to better pain control. Future research should model pathways through which clinician-patient communication can lead to better cancer outcomes.
authors.affiliation: Texas A&M University, College Station, TX, USA; Houston Center for Healthcare Innovation, Quality, and Safety and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tancredi
authors.forename: Christina
authors.initials: C
authors.lastname: Slee
authors.forename: Donna K
authors.initials: DK
authors.lastname: Kalauokalani
authors.forename: Dionne Evans
authors.initials: DE
authors.lastname: Dean
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010353:Patient Education as Topic; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012017:Referral and Consultation; D016896:Treatment Outcome
keywords: communication pathways; pain control; patient participation; physician behavior; physician-patient communication