The Power Over Pain Coaching Intervention Improves Functional Status in African Americans With Cancer Pain

2.50
Hdl Handle:
http://hdl.handle.net/10755/622012
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
The Power Over Pain Coaching Intervention Improves Functional Status in African Americans With Cancer Pain
Other Titles:
Functional Status of Oncology Patients
Author(s):
Vallerand, April; Hasenau, Susan M.; Templin, Thomas
Lead Author STTI Affiliation:
Lambda
Author Details:
April Vallerand, PhD, RN, FAAN, Professional Experience: My research involves the maintenance and improvement of functional status in patients with chronic pain. I have research and publications on patients with chronic cancer, HIV, and non- malignant pain. My most recent study involved improving cancer pain management in home care patients with cancer. This was funded by the National Cancer Institute and publications from this study can be found in Oncology Nursing Forum and Home Healthcare Nurse. A secondary study examined pain in cancer outpatients and the results were published in Pain Medicine. Author Summary: A recognized nursing leader and scholar, Dr. Vallerand is widely published on the topic of pain management, including: the maintenance and improvement of functional status in patients with chronic pain, pain-related disparities, cancer pain management, symptom clusters in patients with cancer, pharmacological management of pain, the use of opioids in the management of chronic pain, self-treatment of pain in the community, and the perceived control and coping in patients with chronic pain.
Abstract:

Purpose:  Functional status, or the ability to carry out meaningful activities, is affected by pain intensity and the patient’s belief that they can control the pain to an extent that allows them to participate in those activities1African Americans have been found to have higher levels of pain, more pain-related distress, and lower functional status than their Caucasian non-ethnic cohorts2,3,4. Pain-related distress has been shown to mediate the relationship between pain and function5,6. Although pain-related distress is important and should be assessed in all patients with pain, designing interventions to decrease distress is challenging due to the affective nature of the concept. The factors that lead to pain-related distress are more amenable to intervention strategies. Certainly decreasing pain may lead to decreasing distress, however, there may be other factors affecting distress. Perceived control over pain, a factor that had not been previously taken into account, was found to have a direct effect on pain-related distress and mediated the effect of beliefs about pain and pain level on distress in ambulatory patients with cancer-related pain1. In a previous study, perceived control over pain was found to partially mediate the relationship between pain and functional status in adults with low income attending a primary care clinic7. The purpose of this longitudinal randomized control trial was to test the 3-component Power Over Pain – Coaching (POP-C) intervention with 236 African American patients recruited from an urban comprehensive cancer center.

Methods:  Participants were 63% (196) female, mean age was 56.28 years (SD = 11.49). Average pain in past 24 hours from the Brief Pain Inventory (BPI) composite was 5.81 (SD = 2.40) on a 0-10 scale. The components of Medication Management, Pain Advocacy, and Living with Pain were tailored to African Americans, individualized to the patient, and delivered over 5 weeks. Components were measured by existing and investigator-developed instruments. Perceived control over pain, measured by cognitive, pharmacologic, and emotional control, and feelings of control, was a mediator of the outcomes of pain, pain-related distress, and functional status. The primary outcomes of pain, pain-related distress, and functional status were measured weekly. Intermediate outcomes of perceived control over pain and measure of the intervention components were measured at baseline, week 7 (evaluation of intervention), and week 12 (durability).

Results:  There were no baseline differences in gender, marital status, education, metastasis, perceived control over pain, pain, pain-related distress, and functional status. As typical with behavioral intervention trials, a monotone pattern of missing data was observed due to death (5%), illness (10%), and lost to follow-up (9%). The total complete case sample was 236 (24% incomplete cases). Including baseline characteristics in the models did not make any difference in the estimation of treatment effects. Linear mixed model analyses of the primary outcomes of pain, pain-related distress, and functional status, showed significant linear decreases in each of the outcome measures over the 7 week over the 7 weeks between baseline and intervention evaluation (p <.01). Intervention effects were tested by comparing linear trends across groups. Intent-to-treat (ITT) and complete-case analyses gave similar results for pain-related distress and functional status; in both, differences in linear trend were significant as predicted (p < .01). The difference in linear trend for pain was not significant in the ITT (p = .065) but significant in complete case analysis (p = .041).

Conclusion:

This study demonstrated improving perceived control over pain decreases pain-related distress and improves functional status in African Americans with cancer-related pain. Results from a previous study supported the need for nurses to incorporate perceived control over pain as part of the assessment process and to intervene using the potential methods for increasing perception of control over pain as discussed8. Potential nursing interventions for increasing control over pain include: educating patients about pain management modalities; individualizing therapy to meet patient’s needs including acceptable modifications of pharmacological regimen; providing options for patients to manage episodes of breakthrough pain; teaching patients how to use nonpharmacological modalities; and educating patients about when to call the clinician if pain is not controlled5,9. The stronger effects observed for pain-related distress and functional status were anticipated because the POP-C intervention was expected to reduce distress and increase functional status irrespective of pain. Perceived control over pain was strongly associated with pain-related distress and is more amenable to the development of nursing interventions that can improve functional status. These results support the POP-C intervention and, validate the effects of the POP-C intervention for African Americans with cancer pain. Transforming these findings into practice, use of the components of the POP-C intervention when caring for African American patients with cancer pain will allow nurses to increase patient’s perceived control over pain, leading to improved functional status.

Keywords:
functional status; perceived control over pain; pain related distress
Repository Posting Date:
21-Jul-2017
Date of Publication:
21-Jul-2017
Other Identifiers:
INRC17I06
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleThe Power Over Pain Coaching Intervention Improves Functional Status in African Americans With Cancer Painen_US
dc.title.alternativeFunctional Status of Oncology Patientsen
dc.contributor.authorVallerand, Aprilen
dc.contributor.authorHasenau, Susan M.en
dc.contributor.authorTemplin, Thomasen
dc.contributor.departmentLambdaen
dc.author.detailsApril Vallerand, PhD, RN, FAAN, Professional Experience: My research involves the maintenance and improvement of functional status in patients with chronic pain. I have research and publications on patients with chronic cancer, HIV, and non- malignant pain. My most recent study involved improving cancer pain management in home care patients with cancer. This was funded by the National Cancer Institute and publications from this study can be found in Oncology Nursing Forum and Home Healthcare Nurse. A secondary study examined pain in cancer outpatients and the results were published in Pain Medicine. Author Summary: A recognized nursing leader and scholar, Dr. Vallerand is widely published on the topic of pain management, including: the maintenance and improvement of functional status in patients with chronic pain, pain-related disparities, cancer pain management, symptom clusters in patients with cancer, pharmacological management of pain, the use of opioids in the management of chronic pain, self-treatment of pain in the community, and the perceived control and coping in patients with chronic pain.en
dc.identifier.urihttp://hdl.handle.net/10755/622012-
dc.description.abstract<p><strong>Purpose: </strong><span> Functional status, or the ability to carry out meaningful activities, is affected by pain intensity and the patient’s belief that they can control the pain to an extent that allows them to participate in those activities</span><sup>1</sup><strong>. </strong><span>African Americans have been found to have higher levels of pain, more pain-related distress, and lower functional status than their Caucasian non-ethnic cohorts</span><sup>2,3,4</sup><span>. Pain-related distress has been shown to mediate the relationship between pain and function</span><sup>5,6</sup><span>. Although pain-related distress is important and should be assessed in all patients with pain, designing interventions to decrease distress is challenging due to the affective nature of the concept. The factors that lead to pain-related distress are more amenable to intervention strategies. Certainly decreasing pain may lead to decreasing distress, however, there may be other factors affecting distress. Perceived control over pain, a factor that had not been previously taken into account, was found to have a direct effect on pain-related distress and mediated the effect of beliefs about pain and pain level on distress in ambulatory patients with cancer-related pain</span><sup>1</sup><span>. In a previous study, perceived control over pain was found to partially mediate the relationship between pain and functional status in adults with low income attending a primary care clinic</span><sup>7</sup><span>. The purpose of this longitudinal randomized control trial was to test the 3-component Power Over Pain – Coaching (POP-C) intervention with 236 African American patients recruited from an urban comprehensive cancer center.</span></p> <p><strong>Methods: </strong> Participants were 63% (196) female, mean age was 56.28 years (<em>SD</em> = 11.49). Average pain in past 24 hours from the Brief Pain Inventory (BPI) composite was 5.81 (<em>SD</em> = 2.40) on a 0-10 scale. The components of Medication Management, Pain Advocacy, and Living with Pain were tailored to African Americans, individualized to the patient, and delivered over 5 weeks. Components were measured by existing and investigator-developed instruments. Perceived control over pain, measured by cognitive, pharmacologic, and emotional control, and feelings of control, was a mediator of the outcomes of pain, pain-related distress, and functional status. The primary outcomes of pain, pain-related distress, and functional status were measured weekly. Intermediate outcomes of perceived control over pain and measure of the intervention components were measured at baseline, week 7 (evaluation of intervention), and week 12 (durability).</p> <p><strong>Results: </strong> There were no baseline differences in gender, marital status, education, metastasis, perceived control over pain, pain, pain-related distress, and functional status. As typical with behavioral intervention trials, a monotone pattern of missing data was observed due to death (5%), illness (10%), and lost to follow-up (9%). The total complete case sample was 236 (24% incomplete cases). Including baseline characteristics in the models did not make any difference in the estimation of treatment effects. Linear mixed model analyses of the primary outcomes of pain, pain-related distress, and functional status, showed significant linear decreases in each of the outcome measures over the 7 week over the 7 weeks between baseline and intervention evaluation (p <.01). Intervention effects were tested by comparing linear trends across groups. Intent-to-treat (ITT) and complete-case analyses gave similar results for pain-related distress and functional status; in both, differences in linear trend were significant as predicted (p < .01). The difference in linear trend for pain was not significant in the ITT (p = .065) but significant in complete case analysis (p = .041).</p> <p><strong>Conclusion:</strong></p> <p>This study demonstrated improving perceived control over pain decreases pain-related distress and improves functional status in African Americans with cancer-related pain. Results from a previous study supported the need for nurses to incorporate perceived control over pain as part of the assessment process and to intervene using the potential methods for increasing perception of control over pain as discussed<sup>8</sup>. Potential nursing interventions for increasing control over pain include: educating patients about pain management modalities; individualizing therapy to meet patient’s needs including acceptable modifications of pharmacological regimen; providing options for patients to manage episodes of breakthrough pain; teaching patients how to use nonpharmacological modalities; and educating patients about when to call the clinician if pain is not controlled<sup>5,9</sup>. The stronger effects observed for pain-related distress and functional status were anticipated because the POP-C intervention was expected to reduce distress and increase functional status irrespective of pain. Perceived control over pain was strongly associated with pain-related distress and is more amenable to the development of nursing interventions that can improve functional status. These results support the POP-C intervention and, validate the effects of the POP-C intervention for African Americans with cancer pain. Transforming these findings into practice, use of the components of the POP-C intervention when caring for African American patients with cancer pain will allow nurses to increase patient’s perceived control over pain, leading to improved functional status.</p>en
dc.subjectfunctional statusen
dc.subjectperceived control over painen
dc.subjectpain related distressen
dc.date.available2017-07-21T16:25:16Z-
dc.date.issued2017-07-21-
dc.date.accessioned2017-07-21T16:25:16Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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