REPRESENTATIONAL INTERVENTION FOR CANCER PAIN

University Of Wisconsin Madison, Madison WI

Investigators

Linked publications & trials

Abstract

DESCRIPTION (Adapted from the Investigator's Abstract): Many persons with cancer have beliefs about reporting pain and using analgesics (e.g., concern about side effects and fear of addiction) that interfere with their ability to cope with pain. These beliefs are termed patient-related barriers to pain management. Individuals who endorse these barriers tend to under-utilize analgesics; those not endorsing these barriers tend to use adequate analgesics. We tested the impact of a standardized educational intervention (SEI) comprised of: (a) sensory and coping information for analgesic side effect management, and (b) information intended to change beliefs about opioids. Preliminary analyses reveal statistically significant but small differences in analgesic use in the intervention and the care-as-usual control group; those receiving the intervention were more likely to use adequate analgesics. The intervention, however, had no impact on the hypothesized mediator (change in beliefs). To improve the effect size for analgesic use, and to have an impact on beliefs and overall quality of life (QOL) we plan to test an individualized intervention based on patients' representations of cancer pain. A representation is a set of beliefs about the cause, temporal course, consequences, cure/control, and identity of a health problem. By addressing patients representations of cancer pain, we may be able to change beliefs that act as barriers to adequate analgesic use, thereby improving QOL. Patients with metastatic or progressive breast, prostate, or lung cancer of multiple myeloma will be randomized to: (a) the SEI that we tested in the previous study; (b) SEI plus an individualized representational intervention (SEI-REP); or, (c) care-as-usual control. QOL outcomes are perceived health and well-being. Proposed mediators are beliefs (barriers) and coping (analgesic use). Valid and reliable measures of study variables will be obtained at baseline and one and two months later. Specific aims are to: (1) evaluate the efficacy of the representational intervention among adults with cancer pain. We predict that those receiving SEI-REP will have better QOL outcomes compared to those receiving SEI alone who will in turn have better outcomes than the control group. (2) Examine mechanisms -- test for mediation effects. We predict that the representational intervention will have an impact on beliefs which in turn affect coping (appropriate use of analgesics) and that coping will affect QOL outcomes. Subjects will be recruited from three medical oncology clinics in Wisconsin, one of which serves substantial numbers of minority patients. Power analyses revealed that 194 subjects are needed for hypothesis testing; 232 will be recruited so that after dropout, 194 are on study.