Supportive Care in Cancer

, Volume 21, Issue 12, pp 3529–3537 | Cite as

Optimal patient education for cancer pain: a systematic review and theory-based meta-analysis

  • N. MarieEmail author
  • T. Luckett
  • P. M. Davidson
  • M. Lovell
  • S. Lal
Review Article



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.


Cancer pain COM-B model Meta-analysis 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • N. Marie
    • 1
    Email author
  • T. Luckett
    • 2
  • P. M. Davidson
    • 3
  • M. Lovell
    • 4
  • S. Lal
    • 5
  1. 1.School of Medical and Molecular BiosciencesUniversity of Technology SydneyUltimoAustralia
  2. 2.Improving Palliative Care through Clinical Trials (ImPaCCT) Faculty of HealthUTS South West Sydney Clinical School, UNSWUltimoAustralia
  3. 3.Centre for Cardiovascular and Chronic Care, Faculty of HealthUniversity of Technology SydneyUltimoAustralia
  4. 4.Palliative MedicineGreenwich Hospital Improving Palliative Care through Clinical Trials (ImPaCCT)UltimoAustralia
  5. 5.School of Medical and Molecular BiosciencesUniversity of Technology SydneyUltimoAustralia

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