Martinez, K.A., Aslakson, R.A., Wilson, R.F., Apostol, C.C., Fawole, O.A., Lau, B.D., . . . Dy, S.M. (2014). A systematic review of health care interventions for pain in patients with advanced cancer. American Journal of Hospice and Palliative Care, 31, 79–86.

STUDY PURPOSE: To evaluate the effectiveness of healthcare interventions targeting pain in patients with cancer

TYPE OF STUDY: Systematic review

DATABASES USED: PubMed, CINAHL, PsycINFO, DARE, and Cochrane Collaboration; reference lists were used to identify additional studies.

KEYWORDS: Search terms and strategy specifics are in an online appendix to this article.

INCLUSION CRITERIA: Random or nonrandom trials with a control group. Patient-centered and institutional change interventions were included in the definition of healthcare interventions. Pain was included as an outcome.

EXCLUSION CRITERIA: Not specified

TOTAL REFERENCES RETRIEVED = 1,3014

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: GRADE system of quality evaluation; risk of bias was high in seven studies and moderate in another seven studies.

• FINAL NUMBER STUDIES INCLUDED = 19 
• TOTAL PATIENTS INCLUDED IN REVIEW = 97
• KEY SAMPLE CHARACTERISTICS: Mixed tumor types; median follow-up was 8 weeks (range was 2–24 weeks); all had advanced cancer.

APPLICATIONS: Palliative care

Of the studies, 89% examined patient educational activities. Two focused on provider-level interventions. Fifty-five percent of studies (11 studies) that measured knowledge and barriers found significant improvement in barriers to pain management. Five studies measured pain knowledge–two of these showed improvement. Forty-seven percent of the 19 studies showed significant improvement in pain outcomes compared to the control group. Findings varied by the type of intervention used, and results suggest that the use of multiple educational modalities may be more effective. The number of patient encounters in studies varied widely.

Psychoeducational interventions significantly can reduce barriers to pain management, improve pain knowledge, and improve pain outcomes.

• Many studies had small sample sizes and moderate to high risk of bias. 
• The samples had little ethnic diversity. 
• Although most used the Brief Pain Inventory, studies used different components of the tool and individual subscales only.

Psychoeducational interventions can reduce patient barriers to pain management, improve relevant knowledge, and have a positive impact on pain. Multimodal interventions combining various educational media and follow-up appear to be more effective than alternatives. Data are limited to show effects of institutional, provider-focused interventions, but results in this area are promising. A combination of provider- and patient-focused interventions should be evaluated.