Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis
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Previous systematic reviews have found patient education to be moderately efficacious in decreasing the intensity of cancer pain, but variation in results warrants analysis aimed at identifying which strategies are optimal.
A systematic review and meta-analysis was undertaken using a theory-based approach to classifying and comparing educational interventions for cancer pain. The reference lists of previous reviews and MEDLINE, PsycINFO, and CENTRAL were searched in May 2012. Studies had to be published in a peer-reviewed English language journal and compare the effect on cancer pain intensity of education with usual care. Meta-analyses used standardized effect sizes (ES) and a random effects model. Subgroup analyses compared intervention components categorized using the Michie et al. (Implement Sci 6:42, 2011) capability, opportunity, and motivation behavior (COM-B) model.
Fifteen randomized controlled trials met the criteria. As expected, meta-analysis identified a small-moderate ES favoring education versus usual care (ES, 0.27 [−0.47, −0.07]; P = 0.007) with substantial heterogeneity (I² = 71 %). Subgroup analyses based on the taxonomy found that interventions using “enablement” were efficacious (ES, 0.35 [−0.63, −0.08]; P = 0.01), whereas those lacking this component were not (ES, 0.18 [−0.46, 0.10]; P = 0.20). However, the subgroup effect was nonsignificant (P = 0.39), and heterogeneity was not reduced. Factoring in the variable of individualized versus non-individualized influenced neither efficacy nor heterogeneity.
The current meta-analysis follows a trend in using theory to understand the mechanisms of complex interventions. We suggest that future efforts focus on interventions that target patient self-efficacy. Authors are encouraged to report comprehensive details of interventions and methods to inform synthesis, replication, and refinement.
KeywordsCancer pain COM-B model Meta-analysis
- 3.Scottish Intercollegiate Network (SIGN) (2008) Control of pain in patients with cancer: a national clinical guideline. SIGN, EdinburghGoogle Scholar
- 4.NHS Quality Improvement Scotland (2004) Best practice statement: the management of pain in patients with cancer. NHS Quality Improvement Scotland, EdinburghGoogle Scholar
- 5.National Comprehensive Cancer Network (NCCN) (2011) NCCN clinical practice guidelines in oncology: adult cancer pain. Version 2.2011. NCCN, New YorkGoogle Scholar
- 6.NICE clinical guideline 140 (2012) Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults. NICE, LondonGoogle Scholar
- 23.Higgins J (2008) Chapter 8: Assessing risk of bias in included studies. Cochrane Handbook for Systematic Reviews of Interventions, vol 5.0.1. The Cochrane CollaborationGoogle Scholar
- 24.The Cochrane Collaboration (2011) Review manager, 51st edn. The Nordic Cochrane Centre, CopenhagenGoogle Scholar
- 25.Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, LondonGoogle Scholar
- 30.Bozcuk H, Kolagasi O, Samur M, Yıldız M, Ozdogan M, Artac M, Savas B (2003) A brief information sheet on opioid effects improves quality of life in cancer patients on opioids. Internet J Pain Symptom Control Palliat Care 2(2)Google Scholar
- 34.De Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, Leenhouts G, Duivenvoorden H, Huijer Abu-Saad H (2001) Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain. Eur J Pain 5(3):241–256, London, EnglandPubMedCrossRefGoogle Scholar
- 36.Lai YH, Guo SL, Keefe FJ, Tsai SL, Chien CC, Sung YC, Chen ML (2004) Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 9:645–652Google Scholar
- 37.Lovell MR, Forder PM, Stockler MR, Butow P, Briganti EM, Chye R, Goldstein D, Boyle FM (2010) A randomized controlled trial of a standardized educational intervention for patients with cancer pain. J Pain Symptom Manage 40(1):49–59. doi: 10.1016/j.jpainsymman.2009.12.013 PubMedCrossRefGoogle Scholar
- 39.Ward SE, Serlin RC, Donovan HS, Ameringer SW, Hughes S, Pe-Romashko K, Wang K-K (2009) A randomized trial of a representational intervention for cancer pain: does targeting the dyad make a difference? Health Psychology: Official Journal Of The Division Of Health Psychology. Am Psychol Assoc 28(5):588–597Google Scholar
- 42.Regan JMJ, Peng PP (2000) Neurophysiology of cancer pain. Cancer Control J Moffitt Cancer Cent 7(2):111–119Google Scholar
- 44.Luckett T, Davidson PM, Green A, Boyle F, Stubbs J, Lovell MR (2012) Assessment and management of adult cancer pain: a systematic review and synthesis of recent qualitative studies aimed at developing insights for managing barriers and optimizing facilitators within a comprehensive framework of patient care. J Pain Symptom Manage 46(2):229–53PubMedCrossRefGoogle Scholar
- 47.Cartmell RC, Coles A (2000) Informed choice in cancer pain: empowering the patient. Br J Commun Nurs 5(11):560Google Scholar
- 49.Marks R, Allegrante JP, Lorig K (2005) A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract 6(2):148–156. doi: 10.1177/1524839904266792 PubMedCrossRefGoogle Scholar