A Stepped-Wedge Randomized Controlled Trial: Effects of eHealth Interventions for Pain Control Among Adults With Cancer in Hospice
| Autor: | Adrienne Butler, David Shuey, Yingwei Yao, Anayza Gill, Jessica Perez, Robert Shea, Michael Murray, Joanna Martin, Zaijie Jim Wang, Theresa Hipp, Jesus Carrasco, Diana J. Wilkie, Marie L. Suarez, Veronica Angulo, Miriam O. Ezenwa, Jacob Miller, Julie Glendenning, Timothy McCurry, Robert E. Molokie, Nargis Nardi, Brenda W Dyal, Karen M. Frank |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Analgesic Psychological intervention Context (language use) law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Neoplasms eHealth Humans Pain Management Medicine 030212 general & internal medicine Medical prescription General Nursing business.industry Hospices Telemedicine Hospice Care Anesthesiology and Pain Medicine Caregivers 030220 oncology & carcinogenesis Neuropathic pain Physical therapy Female Neurology (clinical) business Cancer pain |
| Zdroj: | Journal of Pain and Symptom Management. 59:626-636 |
| ISSN: | 0885-3924 |
| Popis: | Context Unrelieved cancer pain at the end of life interferes with achieving patient-centered goals. Objective To compare effects of usual hospice care and PAINRelieveIt® on pain outcomes in patients and their lay caregivers. Methods In a five-step, stepped-wedge randomized, controlled study, 234 patients (49% male, 18% Hispanic, 51% racial minorities) and 231 lay caregivers (26% male, 20% Hispanic, 54% racial minorities) completed pre-pain/post-pain measures. They received usual hospice care with intervention components that included a summary of the patient's pain data, decision support for hospice nurses, and multimedia education tailored to the patient's and lay caregiver's misconceptions about pain. Results The intervention effect on analgesic adherence (primary outcome) was not significant. Post-test worst pain intensity was significantly higher for the experimental group, but the difference (0.70; CI = [0.12, 1.27]) was not clinically meaningful. There was nearly universal availability of prescriptions for strong opioids and adjuvant analgesics for neuropathic pain in both groups. Lay caregivers' pain misconceptions (0-5 scale) were significantly lower in the experimental group than the usual care group (mean difference controlling for baseline is 0.38; CI = [0.08, 0.67]; P = 0.01). Conclusion This randomized controlled trial was a negative trial for the primary study outcomes but positive for a secondary outcome. The trial is important for clearly demonstrating the feasibility of implementing the innovative set of interventions. |
| Databáze: | OpenAIRE |
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