title: A qualitative study of patient and provider perspectives on using web-based pain coping skills training to treat persistent cancer pain.
abstract: Persistent pain is common and inadequately treated in cancer patients. Behavioral pain interventions are a recommended part of multimodal pain treatments, but they are underused in clinical care due to barriers such as a lack of the resources needed to deliver them in person and difficulties coordinating their use with clinical care. Pain coping skills training (PCST) is an evidence-based behavioral pain intervention traditionally delivered in person. Delivering this training via the web would increase access to it by addressing barriers that currently limit its use. We conducted a patient pilot study of an 8-week web-based PCST program to determine the acceptability of this approach to patients and the program features needed to meet their needs. Focus groups with healthcare providers identified strategies for coordinating the use of web-based PCST in clinical care.
  
  
  
  Participants included 7 adults with bone pain due to multiple myeloma or metastasized breast or prostate cancer and 12 healthcare providers (4 physicians and 8 advanced practice providers) who treat cancer-related bone pain. Patients completed web-based PCST at home and then took part in an in-depth qualitative interview. Providers attended focus groups led by a trained moderator. Qualitative analyses identified themes in the patient and provider data.
  
  
  
  Patients reported strongly favorable responses to web-based PCST and described emotional and physical benefits. They offered suggestions for adapting the approach to better fit their needs and to overcome barriers to completion. Focus groups indicated a need to familiarize healthcare providers with PCST and to address concerns about overburdening patients. Providers would recommend the program to patients they felt could benefit. They suggested applying a broad definition of cancer pain and having various types of providers help coordinate program its use with clinical care.
  
  
  
  Web-based PCST was acceptable to patients and providers. Our findings suggest that patients could benefit from this approach, especially if patient and provider barriers are addressed.
authors.affiliation: Department of Health Behavior,Gillings School of Global Public Health,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Christine
authors.initials: C
authors.lastname: Rini
authors.affiliation: Lineberger Comprehensive Cancer Center,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Maihan B
authors.initials: MB
authors.lastname: Vu
authors.affiliation: Department of Health Behavior,Gillings School of Global Public Health,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Hannah
authors.initials: H
authors.lastname: Lerner
authors.affiliation: Duke Clinical Research Institute,Durham,North Carolina.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bloom
authors.affiliation: Lineberger Comprehensive Cancer Center,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Jessica
authors.initials: J
authors.lastname: Carda-Auten
authors.affiliation: Lineberger Comprehensive Cancer Center,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Lineberger Comprehensive Cancer Center,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Basch
authors.affiliation: Levine Cancer Institute,Carolinas HealthCare System,Charlotte,North Carolina.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Voorhees
authors.affiliation: Lineberger Comprehensive Cancer Center,University of North Carolina,Chapel Hill,North Carolina.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Reeder-Hayes
authors.affiliation: Duke University Medical Center,Durham,North Carolina.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000223:Adaptation, Psychological; D001521:Behavior Therapy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D000072716:Cancer Pain / Q000523:psychology / Q000628:therapy*; D005260:Female; D017144:Focus Groups; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D036301:Qualitative Research
keywords: Cancer pain; Cognitive behavioral intervention; Pain coping skills training; Pain management; eHealth