Project Summary
Unrelieved cancer pain at the end of life is a major health problem and inconsistent with patient-centered goals. Building on a successful approach in outpatient oncology clinics, we propose a study testing PAINRelieveIt, a system-level intervention of computerized tools with patient-reported pain outcomes (available in English, Spanish, Chinese languages), decision support for clinicians (English), and multimedia education tailored to each cancer patient and lay caregiver. Using a one-week randomized design in patients receiving care provided by two Chicago-area hospices, we will compare effects of usual hospice care and PAINRelieveIt on pain outcomes. The tablet-based PAINRelieveIt includes valid and reliable pain tools (PAINReportIt), a summary of the patient’s pain data with decision support for hospice nurses to obtain recommendations for analgesic therapies (PAINConsultN), and multimedia education tailored to the patient’s and lay caregiver’s pain management misconceptions (PainUCope). Patient’s/caregiver’s answers are automatically stored in an electronic database, from which the system generates information for patients/caregivers and hospice nurses. All patients will receive usual hospice care. All patients/caregivers will complete PAINReportIt at pre-test and one week later (post-test); patients also complete parts of it daily. Via daily e-mail updates, the control-group hospice nurses will receive a PAINReportIt Summary, and experimental-group hospice nurses will receive a PAINConsultN. Additionally, experimental-group patients/caregivers will view multimedia educational materials via PAINUCope to help patients report pain and adhere to prescribed analgesics.
Specific aims are to compare usual hospice care and PAINRelieveIt groups for effects on:
- patient outcomes (analgesic adherence, worst pain intensity, satisfaction, and misconceptions) and lay caregiver outcome (pain misconceptions) in a diverse sample of 250 cancer patient-caregiver dyads receiving hospice care; and
- nurse outcomes (obtained appropriate analgesics for patient) in a sample of hospice nurses.
We hypothesize that at post-test, controlling for pre-test data and compared to the usual care group, the PAINRelieveIt group will:
- report decreased scores for worst pain intensity and pain misconceptions;
- have increased analgesic adherence (primary outcome); and
- have a larger proportion who report satisfaction with pain intensity and whose nurses obtained appropriate analgesics for the patients’ pain.
Findings will guide future system-level research to implement PAINRelieveIt in a multi-site, longitudinal trial that will test the effect of disseminating this technology on clinical decisions for managing pain and patient/caregiver pain outcomes in a national sample of hospices. This approach offers improved pain control for dying patients and other populations.
Ezenwa MO, Suarez ML, Carrasco JD, Hipp T, Gill A, Miller J, Shea R, Shuey D, Zhao Z, Angulo V, McCurry T, Martin J, Yao Y, Molokie RE, Wang ZJ, Wilkie DJ. Implementing the PAINRelieveIt Randomized Controlled Trial in Hospice Care: Mechanisms for Success and Meeting PCORI Methodology Standards. West J Nurs Res. 2016 Sep 12. pii: 0193945916668328. [Epub ahead of print] PubMed PMID: 27621272. (Abstract only available)
Wilkie DJ, Ezenwa MO, Yao Y, Gill A, Hipp T, Shea R, Miller J, Carrasco J, Shuey D, Zhao Z, Angulo V, Suarez ML, McCurry T, Martin J, Molokie RE, Wang ZW. Pain Intensity and Misconceptions Among Hospice Patients With Cancer and Their Caregivers: Status After 2 Decades. Am J Hosp Palliat Care. 2016 Mar 22. pii: 1049909116639612. [Epub ahead of print] PubMed PMID: 27006391. (Abstract only available)
^ Diana J. Wilkie, BSN, MS, PhD, was the original principal investigator for this project.
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