Ward, S.E., Wang, K.K., Serlin, R.C., Peterson, S.L., & Murray, M.E. (2009). A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain. Pain, 144(1–2), 49–56.

To test the efficacy of a tailored intervention regarding patient barriers to pain management and pain duration, pain severity, and pain-related interference with daily life

Patients who called the Cancer Information Service and reported moderate to severe pain were asked to stay on the line and queried about consent for study participation. Consenting participants were randomized to one of three groups: the control group, which responded to a single-item screening measure regarding pain and received no intervention; the assessment-only group, which responded to all baseline assessment measurement tools and provided follow-up outcome measures but received no intervention; or the experimental group, which received the intervention. The intervention consisted of determination of barriers, as measured by a standardized assessment, and delivery of a standardized scripted message relating to each barrier identified. Pain duration, pain severity, pain-related interference with life, and barriers were assessed at baseline, during the initial telephone call, and via a follow-up call approximately 28 days after the intervention. Analysis compared the cost of the intervention to the cost of the assessment-only group. Supervisory staff monitored 10% of calls for general quality control regarding eligibility and invitation to participate. Staff who made the follow-up phone calls, to measure outcomes, were blinded to study-group assignment.

• The sample was composed of 1,256 patients who were randomized; 332 patients were in the control group, 332 were in the assessment-only group, and 290 completed the intervention group.
• Mean patient age was 55.77 years. Age range was 39–89 years.
• Of all patients, 74.2% were female and 25.1% were male.
• To be eligible, patients had to state, during the initial telephone interview, that they had at least moderate pain. Of all patients, 63.7% had at least some college-level education; 77.6% were Caucasian and 13.5% were African American.

• Multisite
• Wisconsin

Randomized three-group study

• Single-item on a five-point Likert-type scale, to measure pain severity
• Brief Pain Inventory (selected items)
• Barriers Questionnaire (Short Form)

• In regard to barriers, there was no difference between control and assessment-only groups. The targeted intervention group had a significantly lower postintervention barriers score than did the assessment-only group (p = 0.000, d = 0.47).
• Authors observed no significant differences between groups in regard to pain severity, duration, or interference scores.
• Barriers scores were used in cost comparisons between the intervention and assessment-only groups. Comparisons revealed no differences in cost-effectiveness between these groups.

The targeted telephonic intervention had a positive impact on attitudinal barriers to pain management but had no impact on other pain-related outcomes. In regard to effect on barriers, results were similar in the assessment-only and intervention groups.

• The study had a risk of bias due to no appropriate control group.
• The study design did not allow authors to determine if changes in other aspects of pain management may have affected results.

Providing telephonic assessment of patient barriers to pain management and information about pain management are effective means of reducing those barriers. The effectiveness of the specified interventions and the effect of barrier reduction on overall pain control and management remains unclear.