Rustøen, T., Valeberg, B.T., Kolstad, E., Wist, E., Paul, S., & Miaskowski, C. (2014). A randomized clinical trial of the efficacy of a self-care intervention to improve cancer pain management. Cancer Nursing, 37, 34–43. 

To evaluate the efficacy of a psychoeducational nursing intervention for pain management on pain outcomes

Patients were randomly assigned to control or intervention groups. The intervention was a version of the PRO-SELF pain control program adapted from the work of Miaskowski et al. A specially trained oncology nurse visited patients in their homes on weeks 1, 3, and 6, and did telephone interviews on weeks 2, 4, and 5. Individual patient knowledge deficits were identified based on responses on the pain experience scale, and educational information was tailored to meet individual needs. Patients were given written instructions about pain and the management of adverse effects, and they were taught how to use a weekly pill box and how to use a script to communicate with their physicians about unrelieved pain. During telephone contact, education was reinforced and patients were coached about how to modify pain management or contact the physician to improve pain outcomes. Home visits also involved additional coaching and ongoing education. Patients in the control group were given a booklet about cancer-related pain management and received home visits and telephone interviews with the same timing, focusing on encouraging patients to maintain a pain diary. Pain assessments were done during telephone interviews. The principal investigator listened to tapes of the intervention and control group nurses to ensure the fidelity of the intervention and control conditions.

• N = 147
• MEAN AGE = 65.5 years
• MALES: 52%, FEMALES: 48%
• KEY DISEASE CHARACTERISTICS: Various tumor types; breast and prostate cancer were most frequent. 
• OTHER KEY SAMPLE CHARACTERISTICS: Baseline average pain score was 3.6 and worst pain scores were 5; greater than 50% reported breakthrough pain, and about 50% had been in pain for seven months or more; average daily intake of oral morphine equivalents was 190 mg 

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: Norway

• APPLICATIONS: Palliative care 

Randomized, controlled trial with attention control

• Patients kept daily diary of numeric ratings of pain for least, average, and worst pain and whether they had breakthrough pain episodes.  
• Daily opioid doses were also recorded in the diaries.

There was a significant reduction in least, worst, and average pain in both groups. There were no differences based on group or the combinations of group and time. For both groups, there were significant decreases over time in total doses of opioids taken and no differences between groups in dosage changes. There were no differences between the groups in adjuvant pain medication use or other relevant interventions such as bone-modifying agents.

As used here, the psychoeducational nursing intervention to increase self-care in pain management did not have an impact on pain outcomes. It is not clear if the intervention changed patient behavior in pain management, though both groups in the study had some reduction in pain intensity.

• Risk of bias (no blinding)
• Subject withdrawals ≥ 10%

The psychoeducational intervention used here improved patients’ knowledge about pain management, but it was not clear if it resulted in any behavior change, and there were no differences in pain outcomes between those who received the full intervention and those who were given attention and written instructions for pain control. More evidence is needed to determine the most effective components of this type of intervention. These findings also suggest that the provision of written directions for pain control, daily patient attention via diary use, and simple nursing attention may be as effective as more structured interventions.