Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain

Department of Internal Medicine, University of California Davis, School of Medicine, Sacramento, CA, USA.
BMC Cancer (Impact Factor: 3.36). 09/2009; 9(1). DOI: 10.1186/1471-2407-9-319
Source: PubMed Central


Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes.

The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks.

Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost.

Trial Registration
[Clinical Trials Identifier: NCT00283166]

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    • "The TEC intervention consisted of 6 components summarized by ''ACT-PReP'': (1) assess current knowledge, attitudes , and preferences; (2) correct misconceptions; (3) teach in 2 domains (pain control and patient–physician communication); (4) plan by identifying goals and brainstorming about suitable patient–physician communication strategies; (5) rehearse using role-playing exercises; and (6) portray learned skills. On the basis of a model developed by Oliver et al. [54], the TEC approach uses a specific assessment of each patient's learning needs (using the Short Barriers Questionnaire, SBQ) [75] and goals/values (employing open-ended questioning as guided by training and the ACT- PReP manual) [35], to develop a set of individualized messages and skill-building exercises designed to increase self-efficacy and enhance patient–physician communication. (The ACT-PReP manual is available on request from the authors.) "
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    ABSTRACT: We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.
    Full-text · Article · Mar 2011 · Pain
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    • "A total of 265 patients received either the TEC or EUC, which represented 86% of the patients randomized in the study (see Kravitz et al. [46] for detailed information on patient recruitment). Of these, 148 (56%) additionally consented to have their consultations audio-recorded. "
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    ABSTRACT: This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Grounded in social-cognitive and communication theory, a tailored education-coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients' questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians' communication. Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians' information about pain were higher when patients talked more about their pain concerns. The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.
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