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Randomized Clinical Trial of the Effectiveness of a Self-Care Intervention to Improve Cancer Pain Management

From the Schools of Nursing and Pharmacy, University of California San Francisco, San Francisco, CA; School of Nursing, University of Pennsylvania, Philadelphia, PA; and School of Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.

Address reprint requests to Christine Miaskowski, RN, PhD, Department of Physiological Nursing, University of California, 2 Koret Way, Box 0610-N631Y, San Francisco, CA 94143-0610; e-mail: chris.miaskowski{at}nursing.ucsf.edu

PURPOSE: This randomized clinical trial tested the effectiveness of the PRO-SELF Pain Control Program compared with standard care in decreasing pain intensity scores, increasing appropriate analgesic prescriptions, and increasing analgesic intake in oncology outpatients with pain from bone metastasis.

PATIENTS AND METHODS: Patients were randomly assigned to the PRO-SELF intervention (n = 93) or standard care (n = 81). Patients in the standard care arm were seen by a research nurse three times and were called three times by phone between the home visits. PRO-SELF group patients were seen by specially trained intervention nurses and received a psychoeducational intervention, were taught how to use a pillbox, and were given written instructions on how to communicate with their physician about unrelieved pain and the need for changes in their analgesic prescriptions. Patients were coached during two follow-up home visits and three phone calls on how to improve their cancer pain management.

RESULTS: Pain intensity scores decreased significantly from baseline (all P < .0001) in the PRO-SELF group (ie, least pain, 28.4%; average pain, 32.5%; and worst pain, 27.0%) compared with the standard care group (ie, least increased by 14.6%, average increased by 1.9%, and worst decreased by 1.2%). The percentage of patients in the PRO-SELF group with the most appropriate type of analgesic prescription increased significantly from 28.3% to 37.0% (P = .008) compared with a change from 29.6% to 32.5% in the standard care group.

CONCLUSION: The use of a psychoeducational intervention that incorporates nurse coaching within the framework of self-care can improve the management of cancer pain.

Supported by a grant (CA 64734) from the National Cancer Institute. Additional support for the corresponding author's program of research was provided through unrestricted grants from Janssen Pharmaceutica and Purdue Pharma LP.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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