Wendy H Oldenmenger1, Jenske I Geerling2, Irina Mostovaya3, Kris C P Vissers4, Alexander de Graeff5, Anna K L Reyners6, Yvette M van der Linden7. 1. Department of Medical Oncology, Erasmus MC Cancer Institute, PO Box 5201, 3008 AE Rotterdam, The Netherlands. Electronic address: w.h.oldenmenger@erasmusmc.nl. 2. Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: j.i.geerling@umcg.nl. 3. Knowledge Institute of Medical Specialists, PO Box 3320, 3502 GH Utrecht, The Netherlands. Electronic address: i.mostovaya@kennisinstituut.nl. 4. Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Geer Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands. Electronic address: Kris.Vissers@radboudumc.nl. 5. Cancer Center University Medical Center-Utrecht, Department of Medical Oncology, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address: A.deGraeff@umcutrecht.nl. 6. Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. Electronic address: a.k.l.reyners@umcg.nl. 7. Department of Radiotherapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. Electronic address: ymvanderlinden@lumc.nl.
Abstract
BACKGROUND: Despite existing guidelines to assess and manage pain, the management of cancer-related pain is often suboptimal with patients often being undertreated. Inadequate pain management may be due to patient-related barriers. Educating patients may decrease these barriers. However, the effect of pain education on patient-related outcomes is still unclear. This review aimed to study the effect of educational interventions on cancer-related pain. DESIGN: We performed a systematic review of randomized controlled trials (RCTs) identified from Medline and Cinahl, from 1995 to May 2017. Two reviewers independently selected trials comparing educational intervention to usual care or an active control intervention. The methodological quality was assessed and data extraction was done independently. Primary outcome measures were pain intensity and interference. Secondary outcome measures were knowledge/barriers, medication adherence and self-efficacy. RESULTS: Twenty-six RCTs totaling 4735 patients met our inclusion criteria. Compared to the control group, 31% of the studies (including 19% of all patients) reported a significant difference in pain intensity in favor of the intervention group. Twelve studies measured pain interference and four (30%) found a significant improvement. With regard to secondary endpoints, significant differences in favor of the experimental arms were found for pain knowledge or barriers (15/22 studies; 68%), medication adherence (3/6 studies; 50%) and self-efficacy (1/2 studies). CONCLUSIONS: Patient-based pain educational programs may result in improvements of relevant patient-reported outcomes. However, the interventions are heterogeneous and improvement of pain was only seen in less than one third of the studies and in less than 20% of all included patients.
BACKGROUND: Despite existing guidelines to assess and manage pain, the management of cancer-related pain is often suboptimal with patients often being undertreated. Inadequate pain management may be due to patient-related barriers. Educating patients may decrease these barriers. However, the effect of pain education on patient-related outcomes is still unclear. This review aimed to study the effect of educational interventions on cancer-related pain. DESIGN: We performed a systematic review of randomized controlled trials (RCTs) identified from Medline and Cinahl, from 1995 to May 2017. Two reviewers independently selected trials comparing educational intervention to usual care or an active control intervention. The methodological quality was assessed and data extraction was done independently. Primary outcome measures were pain intensity and interference. Secondary outcome measures were knowledge/barriers, medication adherence and self-efficacy. RESULTS: Twenty-six RCTs totaling 4735 patients met our inclusion criteria. Compared to the control group, 31% of the studies (including 19% of all patients) reported a significant difference in pain intensity in favor of the intervention group. Twelve studies measured pain interference and four (30%) found a significant improvement. With regard to secondary endpoints, significant differences in favor of the experimental arms were found for pain knowledge or barriers (15/22 studies; 68%), medication adherence (3/6 studies; 50%) and self-efficacy (1/2 studies). CONCLUSIONS:Patient-based pain educational programs may result in improvements of relevant patient-reported outcomes. However, the interventions are heterogeneous and improvement of pain was only seen in less than one third of the studies and in less than 20% of all included patients.
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