Shen Megan J, Stokes Tammy, Yarborough Sarah, Harrison Jill
Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, Washington.
Maury Regional Medical Center, Columbia, Tennessee.
JAMA Netw Open. 2024 Jul 1;7(7):e2421298. doi: 10.1001/jamanetworkopen.2024.21298.
Undertreated cancer pain is a major public health concern among older adults in rural communities. Interventions to improve pain management among this vulnerable population are needed.
To test the feasibility, acceptability, and changes in pain outcomes from exposure to an adapted intervention, Cancer Health Empowerment for Living without Pain (CA-HELP), to improve patients' communication about pain to their clinicians.
DESIGN, SETTING, AND PARTICIPANTS: Older adults with cancer (aged ≥65 years) who were residing in a noninstitutional rural setting and receiving outpatient care at a rural-based clinic in Tennessee were enrolled in the study, in which everyone received the intervention, in May 2022. All patients were given assessments at baseline and 1 week after intervention. Mean score differences were analyzed using 1-tailed paired sample t tests (α = .05). Data were analyzed in June 2022.
The adapted version of CA-HELP included an 18-page patient-facing workbook and a 30-minute telephone coaching call with a registered nurse to coach patients on pain education and communication techniques to discuss pain with their medical team.
Feasibility was examined through accrual and completion rates. Acceptability was measured by helpfulness, difficulty, and satisfaction with the intervention. Changes in outcomes were measured using mean score differences from pre-post assessments of pain self-management, self-efficacy for communicating with clinicians about pain, patient-reported pain, and misconceptions about pain.
Among the 30 total participants, the mean (SD) age was 73.0 (5.1) years; 17 participants (56.7%) were female, 5 (16.7%) were Black or African American, 30 (100%) were non-Hispanic or non-Latino, 24 (80.0%) were White, 16 (53.3%) had less than a high school education, and 15 (50.0%) reported income less than $21 000 per year. Based on accrual and completion rates of 100%, this intervention was highly feasible. Fidelity rates for delivering intervention components (100%) and communication competence (27 participants [90%]) were also high. Regarding acceptability, all patients rated the intervention as helpful, with the majority (24 participants [80%]) rating it as "very helpful." Most patients rated the intervention as "not at all difficult" (27 participants [90%]), enjoyed participating (21 participants [70%]), and reported being "very satisfied" (25 participants [83.3%]). Pre-post changes in outcomes suggested significant improvements in pain self-management and self-efficacy for communicating with clinicians about pain, as well as significant reductions in patient-reported pain and pain misconceptions.
In this case-series study of CA-HELP, results suggested the adapted version of CA-HELP was feasible and acceptable and showed changes in pain-related outcome measures among older adults with cancer in a rural setting.
癌症疼痛治疗不足是农村社区老年人的一个主要公共卫生问题。需要采取干预措施来改善这一弱势群体的疼痛管理。
测试一种经过调整的干预措施——“无痛生活癌症健康赋能”（CA-HELP）的可行性、可接受性以及疼痛结局的变化，以改善患者与临床医生之间关于疼痛的沟通。
设计、背景和参与者：2022年5月，居住在田纳西州非机构化农村地区且在农村诊所接受门诊治疗的年龄≥65岁的老年癌症患者被纳入该研究，所有患者均接受了该干预措施。所有患者在基线和干预后1周进行评估。使用单尾配对样本t检验（α = 0.05）分析平均得分差异。2022年6月进行数据分析。
CA-HELP的调整版本包括一本18页面向患者的工作手册以及与注册护士进行的30分钟电话辅导，以指导患者进行疼痛教育和沟通技巧，以便与医疗团队讨论疼痛。
通过入组率和完成率来检验可行性。通过干预的帮助程度、难度以及满意度来衡量可接受性。使用疼痛自我管理、与临床医生沟通疼痛的自我效能、患者报告的疼痛以及对疼痛的误解的前后评估平均得分差异来测量结局变化。
在总共30名参与者中，平均（标准差）年龄为73.0（5.1）岁；17名参与者（56.7%）为女性，5名（16.7%）为黑人或非裔美国人，30名（100%）为非西班牙裔或非拉丁裔，24名（80.0%）为白人，16名（53.3%）教育程度低于高中，1名（50.0%）报告年收入低于21000美元。基于100%的入组率和完成率，该干预措施具有高度可行性。干预组件的实施保真率（100%）和沟通能力（27名参与者[90%]）也很高。关于可接受性，所有患者都认为该干预措施有帮助，大多数（24名参与者[80%]）认为“非常有帮助”。大多数患者认为该干预措施“一点也不难”（27名参与者[90%]），乐于参与（21名参与者[70%]），并报告“非常满意”（25名参与者[83.3%]）。结局的前后变化表明，在疼痛自我管理和与临床医生沟通疼痛的自我效能方面有显著改善，同时患者报告的疼痛和疼痛误解也显著减少。
在这项关于CA-HELP的病例系列研究中，结果表明CA-HELP的调整版本是可行且可接受的，并显示了农村地区老年癌症患者疼痛相关结局指标的变化。
