A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: A study protocol of a quasi-experimental design (original) (raw)
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Effects of a nursing pain programme on patient outcomes
Psycho-Oncology, 1997
The effectiveness of a continuing pain education program, directed to surgical cancer nurses, was investigated in a pretest posttest controlled intervention study. ANCOVA for repeated measures revealed that the programme resulted in a lower pain intensity of surgical colon and breast cancer patients (p = 0.02). However, no effects were found on pain duration, sleepless hours as a result of pain, state anxiety, mood disturbances, and duration of hospitalization. It is assumed that because the pain CE programme had a moderate impact on pain intensity, this had no consequences for the other outcome variables mentioned. This is a NIVEL certified Post Print, more info at http://www.nivel.eu
Pain, 1997
The effectiveness of a Pain Education Program in cancer patients with chronic pain offered by nurses was investigated in a randomized controlled clinical trial. A multi-method approach was used in which verbal instruction, written material, an audio cassette tape, and the use of a pain diary were combined to inform and instruct patients about pain and pain management. The Pain Education Program was tailored to the needs of the individual patient and consisted of three elements: (1) educating patients about the basic principles regarding pain and pain management; (2) instructing patients how to report their pain in a pain diary; and (3) instructing patients how to communicate about pain and how to contact health care providers. Following pretesting in 313 patients, patients who needed district nursing and who did not need district nursing at home were randomly assigned to a control or intervention group. Intervention group patients received the Pain Education Program in the hospital, and 3 and 7 days postdischarge by telephone; this was done by nurses who were specially trained as pain counselors. Follow-up assessments were at 2, 4 and 8 weeks postdischarge. Results of the pretest showed that many patients lacked knowledge about pain and pain management. The majority of pain topics had to be discussed. The Pain Education Program proved to be feasible: 75.0% of the patients had read the entire pain brochure, 55.7% had listened to the audio cassette, and 85.6% of pain scores were completed in the pain diary. Results showed a significant increase in pain knowledge in patients who received the Pain Education Program and a significant decrease in pain intensity. However, pain relief was mainly found in the intervention group patients without district nursing. It can be concluded that the tailored Pain Education Program is effective for cancer patients in chronic pain. The use of the Pain Education Program by nurses should be seriously considered on oncology units.
Pain, 2009
The authors found that patient-based educational interventions significantly reduced cancer pain, although the effect was modest and did not appear to translate into reduced pain in daily activities or improved medication adherence. The review was well conducted, but due to methodological limitations of the primary studies and heterogeneity in the findings these conclusions may require a degree of caution. Authors' objectives To assess the effectiveness of patient-based educational interventions for management of cancer pain. Searching MEDLINE, CINAHL, EMBASE, PsycINFO, ASSIA and AMED were searched from inception to November 2007. The search strategy was available on request. The Cochrane Library, the website of the National Institute for Clinical Excellence and the journals Pain, Journal of Clinical Oncology and Journal of Patient Education and Counseling (1997 to 2007) were also searched. The reference lists of retrieved studies and previous reviews were checked. Data extraction Relative risks (RRs) were calculated for dichotomous data and weighted or standardised mean differences (WMD or SMD) calculated for continuous data. Corresponding 95% confidence intervals (CIs) were calculated. Data were
European Journal of Oncology Nursing, 2006
The purpose of this randomized controlled study was to explore the effectiveness of an educational intervention on nurses' attitudes and knowledge regarding pain management and to explore associations with nurses' characteristics. A four Solomon group experimental design was employed to assess the effect of the intervention and potential effects of pre-intervention testing. One hundred and twelve nurses were randomized to two intervention and two control groups. The intervention was based on viewing a series of educational videotapes and case scenarios. The Validated Hellenic version of the Nurses Knowledge and Attitudes Survey Regarding Pain (GV-NKASRP) was used. Pre-intervention scores revealed various limitations in regard to pain assessment and management. At the pre-test, the average number of correct answers was 17.5877.58 (45.1%719.3% of total questions). Pre-intervention scores differed significantly among participants with different educational backgrounds ðPo0:0001Þ. A significant effect of pain education on total knowledge scores as well as regarding specific questions was detected. Intervention group participants provided 6.1175.55 additional correct answers (15.66%714.23% improvement, Po0:0001), and they exhibited significantly improved post-test scores compared to controls (26.4975.24 vs. 18.7574.48; Po0:0001). A potential negative effect of pre-test on knowledge gain for specific items and for total scores was detected. These findings suggest low pre-test knowledge scores among Hellenic oncology nurses and a significant effect of the intervention.
Patient Education and Counseling, 2004
The persistence of negative attitudes towards cancer pain and its treatment suggests there is scope for identifying more effective pain education strategies. This randomized controlled trial involving 189 ambulatory cancer patients evaluated an educational intervention that aimed to optimize patients' ability to manage pain. One week post-intervention, patients receiving the pain management intervention (PMI) had a significantly greater increase in selfreported pain knowledge, perceived control over pain, and number of pain treatments recommended. Intervention group patients also demonstrated a greater reduction in willingness to tolerate pain, concerns about addiction and side effects, being a "good" patient, and tolerance to pain relieving medication. The results suggest that targeted educational interventions that utilize individualized instructional techniques may alter cancer patient attitudes, which can potentially act as barriers to effective pain management.
2013
Previous studies of cancer-related pain and fatigue guidelines adoption by nurses demonstrated low adoption. The purposes of this study was to follow-up and determine current levels of adoption for pain/fatigue guidelines by outpatient oncology nurses, determine factors that affect adoption, compare results to previous studies, and evaluate effect of survey mode on estimates of adoption rates. A correlational descriptive survey research design was guided by Rogers' Diffusion of Innovation model. Direct care outpatient nurse members of the Oncology Nursing Society (n=8100) were invited to participate in a Web survey (n=8000) or a mailed survey (n=100). The overall response rate was 7% with 563 useable surveys. Response was 18% (n=18) for mail and 7% (n=545) for Web surveys. Cost per useable survey was 20.51forWeband20.51 for Web and 20.51forWeband75.66 for mail surveys. Mann-Whitney U tests found no differences in guideline adoption by survey mode for pain (p=.450) and fatigue (p=.660). Measures included: Oncology Nursing Practice Questionnaire (ONPQ), Research Utilization in Nursing (RU-N), and Perceived Characteristics of Innovating (PCI). Pain guidelines and individual pain practices adoption levels were categorized as use sometimes. Fatigue guidelines adoption was categorized as awareness, but individual fatigue practices was categorized as use sometimes. Mann Whitney U tests indicated guidelines adoption for advanced practice nurses was greater iv than staff nurses for pain (p=<.001) and fatigue (p=<.001). Multiple regression found opinion leadership, experience, education, climate for change, context, policies, and perceptions accounted for 21.4% of variance in pain adoption (R 2 =.23, F(7,500)=20.77, p<.001). Cosmopoliteness, experience, education, climate for change, policies, and perceptions accounted for 21.1% of variance in fatigue adoption (R 2 =.22, F(6,495)=23.33, p<.001). Compared to previous studies, pain guideline scores have improved (M=1.3, SD=1.5), t(519)=8.43, p=<.001, but pain/fatigue practices remain at use sometimes. Adequate instrument reliabilities were obtained for RUN (α = .67 to .91), ONPQ (α = .68 to .75), and PCI (α = .85 to .94). The RUN , ONPQ, and PCI can be successfully converted to Web surveys, cost less, but lower response. Results indicate that pain/fatigue guidelines adoption has not substantially improved, suggesting current strategies to encourage adoption are ineffective and require new approaches.