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Individualized Patient Education and Coaching to Improve Pain Control Among Cancer Outpatients

From the Department of Medicine and Center for Health Services Research in Primary Care, University of California, Davis, CA; and Primary Care Outcomes Research Institute, New England Medical Center, Boston, MA.

Address reprint requests to Richard L. Kravitz, MD, MSPH, Professor and Director, University of California Davis Center for Health Services Research in Primary Care, 4150 V St, PSSB Suite 2500, Sacramento, CA 95817; email: rlkravitz{at}ucdavis.edu

PURPOSE: An estimated 42% of cancer patients suffer from poorly controlled pain, in part because of patient-related barriers to pain control. The objective of this study was to evaluate the effect of an individualized education and coaching intervention on pain outcomes and pain-related knowledge among outpatients with cancer-related pain.

PATIENTS AND METHODS: English-speaking cancer patients (18 to 75 years old) with moderate pain over the past 2 weeks were randomly assigned to the experimental (n = 34) or control group (n = 33). Experimental patients received a 20-minute individualized education and coaching session to increase knowledge of pain self-management, to redress personal misconceptions about pain treatment, and to rehearse an individually scripted patient-physician dialog about pain control. The control group received standardized instruction on controlling pain. Data on average pain, functional impairment as a result of pain, pain frequency, and pain-related knowledge were collected at enrollment and 2-week follow-up.

RESULTS: At baseline, there were no significant differences between experimental and control groups in terms of average pain, functional impairment as a result of pain, pain frequency, or pain-related knowledge. At follow-up, average pain severity improved significantly more among experimental group patients than among control patients (P = .014). The intervention had no statistically significant impact on functional impairment as a result of pain, pain frequency, or pain-related knowledge.

CONCLUSION: Compared with provision of standard educational materials and counseling, a brief individualized education and coaching intervention for outpatients with cancer-related pain was associated with improvement in average pain levels. Larger studies are needed to validate these effects and elucidate their mechanisms.

Presented at the Society of General Internal Medicine Twenty-Second Annual Meeting in San Francisco, CA on May 1, 1999.

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