A Representational Intervention for Cancer Pain

University Of Wisconsin Madison, Madison WI

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Abstract

DESCRIPTION: (provided by applicant) We have developed a theoretically driven approach to patient education that is termed a representational approach. A representation is a set of beliefs about the cause, temporal course, consequences, cure/control, and symptoms of a health problem, such as cancer pain. In a representational approach to patient education, the nurse assesses the patient's representation of a health problem in order to then present highly individualized corrective information to replace misconceptions and in turn change relevant behaviors. We plan to test the effect of this approach on overcoming patient-related barriers to pain management in persons with cancer. Patient-related barriers are beliefs -- such as exaggerated fears of addiction -- that inhibit patients from making optimal use of analgesic medication. In our previous funding period we demonstrated that an earlier version of this intervention, RIDPAIN, decreased patient-related barriers but had little effect on pain outcomes. We have strengthened RIDPAIN, creating RIDPAINplus, by increasing the sessions from one to three to allow time for the creation and evaluation of patient-specific pain management plans. Based on theory and empirical data regarding significant others' involvement in pain management, we propose that a representational approach will be more powerful if it involves significant others rather than just patients alone. The specific aims are: (1) to test hypotheses regarding the efficacy of RIDPAINplus when presented to individuals versus dyads compared to care-as-usual control, and (2) to test hypotheses regarding mediating mechanisms. Subjects will be 180 pairs of patients and significant others recruited from three outpatient oncology clinics. The pairs will be randomly assigned to: (a) Solo- RIDPAINplus (only the patient receives the intervention): (b) Dyad RIDPAINplus (both the patient and the significant other receive the intervention), or (c) care-as-usual. Both RIDPAINplus conditions will involve three contacts during which intervention information is presented --baseline, four weeks later and eight weeks later. Subjects complete measures at baseline, post-test (10 weeks after baseline), and follow-up (14 weeks after baseline). Outcomes are pain severity, mood and quality of life. Proposed mediators are analgesic use, patient and significant other barriers, and patient and significant other communication.