John G Cagle1, Sheryl Zimmerman2, Lauren W Cohen3, Laura S Porter4, Laura C Hanson5, David Reed3. 1. School of Social Work, University of Maryland, Baltimore, Maryland, USA. Electronic address: jcagle@ssw.umaryland.edu. 2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 4. Duke University Medical Center, Durham, North Carolina, USA. 5. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Division of Geriatric Medicine, Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract
CONTEXT: Concerns about pain medications are major barriers to pain management in hospice, but few studies have focused on systematic methods to address these concerns. OBJECTIVES: The objective of this study was to test the preliminary efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention, which included hospice staff education, staff screening of barriers to pain management at admission, and discussion about misunderstandings regarding pain management with family caregivers and patients. METHODS: We conducted a pilot, cluster randomized, controlled trial with four hospices. One hundred twenty-six family caregivers (55 interventions and 71 controls) were interviewed at two weeks after admission. If patients survived three months after admission, caregivers were reinterviewed. RESULTS: At two weeks, caregivers in the intervention group reported better knowledge about pain management (P = 0.001), fewer concerns about pain and pain medications (P = 0.008), and lower patient pain over the past week (P = 0.014) and trended toward improvement in most other areas under study. Exploratory analyses suggest that EMPOWER had a greater effect for black subjects (vs. whites) on reducing concern about stigma. At three months, the intervention group trended better on most study outcomes. CONCLUSION: EMPOWER is a promising model to reduce barriers to pain management in hospice.
RCT Entities:
CONTEXT: Concerns about pain medications are major barriers to pain management in hospice, but few studies have focused on systematic methods to address these concerns. OBJECTIVES: The objective of this study was to test the preliminary efficacy of the Effective Management of Pain: Overcoming Worries to Enable Relief (EMPOWER) intervention, which included hospice staff education, staff screening of barriers to pain management at admission, and discussion about misunderstandings regarding pain management with family caregivers and patients. METHODS: We conducted a pilot, cluster randomized, controlled trial with four hospices. One hundred twenty-six family caregivers (55 interventions and 71 controls) were interviewed at two weeks after admission. If patients survived three months after admission, caregivers were reinterviewed. RESULTS: At two weeks, caregivers in the intervention group reported better knowledge about pain management (P = 0.001), fewer concerns about pain and pain medications (P = 0.008), and lower patientpain over the past week (P = 0.014) and trended toward improvement in most other areas under study. Exploratory analyses suggest that EMPOWER had a greater effect for black subjects (vs. whites) on reducing concern about stigma. At three months, the intervention group trended better on most study outcomes. CONCLUSION: EMPOWER is a promising model to reduce barriers to pain management in hospice.
Authors: Veerawat Phongtankuel; Jeanne A Teresi; Joseph P Eimicke; Jian X Kong; Ronald D Adelman; Holly G Prigerson; Sara J Czaja; Ariel Shalev; Ritchell Dignam; Rosemary Baughn; M Cary Reid Journal: J Palliat Med Date: 2019-12-23 Impact factor: 2.947
Authors: Nai-Ching Chi; George Demiris; Kenneth C Pike; Karla Washington; Debra Parker Oliver Journal: Am J Hosp Palliat Care Date: 2017-09-06 Impact factor: 2.500
Authors: Debra Parker Oliver; George Demiris; Karla Washington; Robin L Kruse; Greg Petroski Journal: Am J Hosp Palliat Care Date: 2016-07-27 Impact factor: 2.500
Authors: Veerawat Phongtankuel; Benjamin A Scherban; Manney C Reid; Amanda Finley; Angela Martin; Jeanne Dennis; Ronald D Adelman Journal: J Palliat Med Date: 2016-01 Impact factor: 2.947