title: EMPOWER: an intervention to address barriers to pain management in hospice.
abstract: BACKGROUND
  Concerns about pain medications are major barriers to pain management in hospice, but few studies have focused on systematic methods to address these concerns.
  
  
  OBJECTIVE
  The objective of this study was to test the preliminary efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention, which included hospice staff education, staff screening of barriers to pain management at admission, and discussion about misunderstandings regarding pain management with family caregivers and patients.
  
  
  METHODS
  We conducted a pilot, cluster randomized, controlled trial with four hospices. One hundred twenty-six family caregivers (55 interventions and 71 controls) were interviewed at two weeks after admission. If patients survived three months after admission, caregivers were reinterviewed.
  
  
  RESULTS
  At two weeks, caregivers in the intervention group reported better knowledge about pain management (P = 0.001), fewer concerns about pain and pain medications (P = 0.008), and lower patient pain over the past week (P = 0.014) and trended toward improvement in most other areas under study. Exploratory analyses suggest that EMPOWER had a greater effect for black subjects (vs. whites) on reducing concern about stigma. At three months, the intervention group trended better on most study outcomes.
  
  
  CONCLUSIONS
  EMPOWER is a promising model to reduce barriers to pain management in hospice.
authors.affiliation: School of Social Work, University of Maryland, Baltimore, Maryland, USA. Electronic address: jcagle@ssw.umaryland.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Cagle
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Porter
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: David
authors.initials: D
authors.lastname: Reed
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D017028:Caregivers / Q000193:education / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D017051:Hospice Care / Q000379:methods*; D006738:Hospices; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000208:ethnology; D059408:Pain Management / Q000379:methods*; D010865:Pilot Projects; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics
keywords: Hospice; addiction; barriers; family caregivers; fears and worries about pain medicine; intervention; pain medicine; palliative care; stigma