Influence of Patient Coaching on Analgesic Treatment Adjustment: Secondary Analysis of a Randomized Controlled Trial

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• 作者：Richard L. Kravitz ; MD ; MSPH^a ; ^d ; ^{rlkravitz@ucdavis.edu} ; Daniel J. Tancredi ; PhD^b ; ^d ; Anthony Jerant ; MD^c ; ^d ; Naomi Saito ; RN ; MS^d ; Richard L. Street ; PhD^e ; Tim Grennan ; MD^f ; Peter Franks ; MD^c ; ^d
• 关键词：Cancer pain ; therapeutic inertia ; pain management ; patient education ; palliative care ; analgesia ; quality of care
• 刊名：Journal of Pain and Symptom Management
• 出版年：2012
• 出版时间：May, 2012
• 年：2012
• 卷：43
• 期：5
• 页码：874-884
• 全文大小：521 K

文摘

Context

For patients with cancer-related pain and their physicians, routine oncology visits are an opportunity to adjust the analgesic regimen and secure better pain control. However, treatment intensification occurs haphazardly in practice.

Objectives

To estimate the effect of patient-centered tailored education and coaching (TEC) on the likelihood of analgesic treatment adjustment during oncology visits, and in turn, the influence of treatment adjustment on subsequent cancer pain control, we studied patients enrolled in a randomized trial of TEC.

Methods

Just before a scheduled oncology visit, 258 patients with at least moderate baseline pain received TEC or control; just after the same visit, they reported on whether the physician recommended a new pain medicine or a change in dose of an existing medicine. Pain severity and pain-related impairment were measured two, six, and 12 weeks later.

Results

Patients assigned to TEC were more likely than controls to report a change in the analgesic treatment regimen (60 % vs. 36 % , P < 0.01); significant effects persisted after adjustment for baseline pain, study site, and physician (adjusted odds ratio 2.61, 95 % confidence interval 1.55, 4.40, P < 0.01). In a mixed-effects repeated measures regression, analgesic change (but not TEC itself) was associated with a sustained decrease in pain severity (P < 0.05).

Conclusion

TEC increases the likelihood of self-reported, physician-directed adjustments in analgesic prescribing, and treatment intensification is associated with better cancer pain outcomes.