Patient-based educational interventions for cancer pain management reduce pain intensity and improve attitudes and knowledge towards cancer pain

Of Bennett, M., Bagnall, A. & Closs, S. J. (2009). How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain, 143, 192-199. Objective of the review: To determine the effectiveness of patient-based educational interventions on cancer pain management through a systematic review and meta-analysis of the published research. Search strategy: Comprehensive search was made of electronic databases (MEDLINE, CINAHL, EMBASE, PsycInfo, ASSIA, AMED, Cochrane Library) from inception to November 2007 and DARE and NICE websites. Search was also made of content lists of key journals and reference lists of retrieved studies and other review articles. Selection criteria Types of studies: Experimental design with comparison group (randomised and non-randomised controlled trials) was used, where control group received usual care or placebo/attention control only. Types of interventions: Information, behavioural instructions and/or advice were provided on an individual basis by a healthcare professional or peer in relation to cancer pain management. Types of participants: Adults with pain from active cancer symptoms (not pain from cancer treatments). Types of outcomes: Main measures were knowledge and attitudes towards cancer pain and analgesia, and pain intensity. Methods of the review: Two reviewers independently selected studies. Data were extracted and methodological quality assessment was undertaken by one reviewer and checked by a second. Quality assessment was derived from the Cochrane Collaboration Handbook (2008). Outcome data were recorded on: knowledge/attitudes towards cancer pain and analgesia, pain intensity, medication adherence, self-efficacy, mood and quality of life. A random effects model was used to combine the effect estimates from the studies where meta-analysis was possible. Main findings: A total of 21 studies met the inclusion criteria with an overall total of 3501 participants with 15 of these studies included in the meta-analysis. Overall patient-based educational interventions improved knowledge and attitudes to cancer pain and analgesia compared with the controls by 0.5 of a point on a five-point scale (Weighted Mean Difference or WMD: 0.52; 95% confidence interval (CI): 0.04 to 1.0). Further, compared with usual care or control, educational interventions reduced average pain intensity by one point on a 10-point scale (WMD 1.1, 95% CI, 0.41 to 1.8). Worst and least pain intensities were also reduced by almost one point (worst pain WMD: 0.78; 95% CI: 0.35 to 1.21; least pain WMD: 0.98; 95% CI: 0.28 to 1.68) and current pain were also reduced (WMD: 0.65; 95% CI: 0.09 to 1.21). Data on the effects of education on self-efficacy and medication adherence were not suitable for meta-analysis. Three studies showed a statistically significant effect of education on self-efficacy, whereas three showed no effect. One study reported a statistically significant positive result on medication adherence, whereas two found no significant difference between education and control groups. Eight studies reported on aspects of pain interference with daily life, with only two showing a statistically significant result between the education and control groups. Authors' conclusion: This review demonstrates modest benefits of patient-based educational interventions in the management of cancer pain. Further research is needed to investigate differences between educational modalities and the timing and duration of interventions. Contact details of author of appraised paper: Michael Bennett; email: m.i.bennett@ lancaster.ac.uk