Diana J Wilkie1, Yingwei Yao2, Miriam O Ezenwa2, Marie L Suarez3, Brenda W Dyal2, Anayza Gill4, Theresa Hipp5, Robert Shea4, Jacob Miller5, Karen Frank4, Nargis Nardi4, Michael Murray5, Julie Glendenning5, Jessica Perez5, Jesus D Carrasco3, David Shuey3, Veronica Angulo3, Timothy McCurry4, Joanna Martin5, Adrienne Butler5, Zaijie Jim Wang6, Robert E Molokie7. 1. Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA. Electronic address: diwilkie@ufl.edu. 2. Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA; University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA. 3. University of Illinois at Chicago, Center for Palliative Care Research & Education (CPCRE), Chicago, Illinois, USA. 4. Rainbow Hospice and Palliative Care, Mount Prospect, Illinois, USA. 5. Horizon Hospice & Palliative Care, Chicago, Illinois, USA. 6. Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA. 7. Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA; Jesse Brown VA Medical Center, Chicago, Illinois, USA.
Abstract
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.
RCT Entities:
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.
Authors: Natasha Ansari; Christina M Wilson; Mallorie B Heneghan; Kathie Supiano; Kathi Mooney Journal: Support Care Cancer Date: 2022-04-12 Impact factor: 3.603
Authors: Stephen J Stapleton; Brenda W Dyal; Andrew D Boyd; Marie L Suarez; Miriam O Ezenwa; Yingwei Yao; Diana J Wilkie Journal: Cancer Nurs Date: 2022-02-16 Impact factor: 2.760
Authors: Janet Jull; Sascha Köpke; Maureen Smith; Meg Carley; Jeanette Finderup; Anne C Rahn; Laura Boland; Sandra Dunn; Andrew A Dwyer; Jürgen Kasper; Simone Maria Kienlin; France Légaré; Krystina B Lewis; Anne Lyddiatt; Claudia Rutherford; Junqiang Zhao; Tamara Rader; Ian D Graham; Dawn Stacey Journal: Cochrane Database Syst Rev Date: 2021-11-08
Authors: Saunjoo L Yoon; Lisa Scarton; Laurie Duckworth; Yingwei Yao; Miriam O Ezenwa; Marie L Suarez; Robert E Molokie; Diana J Wilkie Journal: J Geriatr Oncol Date: 2021-05-07 Impact factor: 3.929