A theory-based educational intervention targeting nurses' attitudes and knowledge concerning cancer-related pain management: a study protocol of a quasi-experimental design

Gunilla Borglin, Markus Gustafsson, Hans Krona, Gunilla Borglin, Markus Gustafsson, Hans Krona

Abstract

Background: Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted.

Methods/design: A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention.

Discussion: Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely.

Trial registration number: ClinicalTrials.gov NCT01313234.

Figures

Figure 1
Figure 1
Overview of study design.
Figure 2
Figure 2
Overview of theory based intervention - workshops.

References

    1. van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18:1437–1449. doi: 10.1093/annonc/mdm056.
    1. Kalyadina SA, Ionova TI, Ivanova MO, Uspenskaya OS, Kishtovich AV, Mendoza TR, Guo H, Novik A, Cleeland CS, Wang XS. Russian Brief Pain Inventory: validation and application in cancer pain. J Pain Symptom Manage. 2008;35:95–102. doi: 10.1016/j.jpainsymman.2007.02.042.
    1. Yun YH, Mendoza TR, Heo DS, Yoo T, Heo BY, Park H, Shin HC, Wang XS, Cleeland CS. Development of a cancer pain assessment tool in Korea: a validation study of a Korean version of the brief pain inventory. Oncology. 2004;66:439–444. doi: 10.1159/000079497.
    1. Mystakidou K, Mendoza T, Tsilika E, Befon S, Parpa E, Bellos G, Vlahos L, Cleeland C. Greek brief pain inventory: validation and utility in cancer pain. Oncology. 2001;60:35–42. doi: 10.1159/000055294.
    1. van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. High prevalence of pain in patients with cancer in a large population-based study in The Netherlands. Pain. 2007;132:312–320. doi: 10.1016/j.pain.2007.08.022.
    1. Mercadante S, Fulfaro F. World Health Organization guidelines for cancer pain: a reappraisal. Ann Oncol. 2005;16(Suppl 4):iv132–135.
    1. Portenoy RK, Lesage P. Management of cancer pain. Lancet. 1999;353:1695–1700. doi: 10.1016/S0140-6736(99)01310-0.
    1. Half of European cancer patients have moderate to severe pain: one in five patients does not receive treatment. J Pain Palliat Care Pharmacother. 2007;21:51–53.
    1. Miaskowski C, Lee KA. Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. J Pain Symptom Manage. 1999;17:320–332. doi: 10.1016/S0885-3924(99)00008-1.
    1. Wells N. Pain intensity and pain interference in hospitalized patients with cancer. Oncol Nurs Forum. 2000;27:985–991.
    1. Randall-David E, Wright J, Porterfield DS, Lesser G. Barriers to cancer pain management: home-health and hospice nurses and patients. Support Care Cancer. 2003;11:660–665. doi: 10.1007/s00520-003-0497-x.
    1. Vallerand AH, Anthony M, Saunders MM. Home care nurses' perceptions of control over cancer pain. Home Healthc Nurse. 2005;23:647–652. doi: 10.1097/00004045-200510000-00009.
    1. Schafheutle EI, Cantrill JA, Noyce PR. Why is pain management suboptimal on surgical wards? J Adv Nurs. 2001;33:728–737. doi: 10.1046/j.1365-2648.2001.01714.x.
    1. Anderson KO. Assessment tools for the evaluation of pain in the oncology patient. Curr Pain Headache Rep. 2007;11:259–264. doi: 10.1007/s11916-007-0201-9.
    1. Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. J Pain Symptom Manage. 2002;24:526–542. doi: 10.1016/S0885-3924(02)00497-9.
    1. Choi YS, Kim SH, Kim JS, Lee J, Kang JH, Kim SY, Kim SY, Kim CS, Song HS, Lim HY, Yim CY, Chung IJ, Cho GJ, Lee MA, Park J, Yeom CH. Change in patients' satisfaction with pain control after using the Korean cancer pain assessment tool in Korea. J Pain Symptom Manage. 2006;31:553–562. doi: 10.1016/j.jpainsymman.2005.10.008.
    1. Howell D, Butler L, Vincent L, Watt-Watson J, Stearns N. Influencing nurses' knowledge, attitudes, and practice in cancer pain management. Cancer Nurs. 2000;23:55–63. doi: 10.1097/00002820-200002000-00009.
    1. Oldenmenger WH, Sillevis Smitt PAE, van Dooren S, Stoter G, van der Rijt CCD. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45:1370–1380. doi: 10.1016/j.ejca.2009.01.007.
    1. Vallerand AH, Riley-Doucet C, Hasenau SM, Templin T. Improving cancer pain management by homecare nurses. Oncol Nurs Forum. 2004;31:809–816. doi: 10.1188/04.ONF.809-816.
    1. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Ajzen I, Fishbein M. The handbook of attitude. Mahwah, NJ: Erlbaum; 2005. The influence of attitude on behavior; pp. 173–221.
    1. Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ. 1997;315:418–421.
    1. Brink PJ, Wood MJ. Advanced design in nursing research. 2. Thousand Oaks Calif.: Sage Publications; 1998.
    1. Vallerand AH, Riley-Doucet C, Hasenau SM, Templin T. Improving cancer pain management by homecare nurses. Oncol Nurs Forum. 2004;31:809–816. doi: 10.1188/04.ONF.809-816.
    1. Lai Y, Guo S, Keefe FJ, Tsai S, Chien C, Sung Y, Chen M. Effects of brief pain education on hospitalized cancer patients with moderate to severe pain. Supportive Care in Cancer. 2003;1:1–1.
    1. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37:378–381. doi: 10.1136/ard.37.4.378.
    1. Scottish Intercollegiate Guidelines Network. Control of pain in adults with cancer: a national clinical guideline. Edinburgh: Scottish Intercollegiate Guidelines Network; 2008. NHS Quality Improvement Scotland.
    1. Ajzen I. Behavioral Interventions Based on the Theory of Planned Behavior. Assessed 6th March 2011.
    1. Jensen MP. The validity and reliability of pain measures in adults with cancer. The Journal of Pain. 2003;4:2–21. doi: 10.1054/jpai.2003.1.
    1. Caraceni A, Cherny N, Fainsinger R, Kaasa S, Poulain P, Radbruch L, De Conno F. Pain Measurement Tools and Methods in Clinical Research in Palliative Care: Recommendations of an Expert Working Group of the European Association of Palliative Care. Journal of Pain and Symptom Management. 2002;23:239–255. doi: 10.1016/S0885-3924(01)00409-2.
    1. Knowledge and Attitudes Survey Regarding Pain. 2008. Developed by Betty Ferrell, RN, PhD, FAAN and Margo McCaffery, RN, MS, FAAN.
    1. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334. doi: 10.1007/BF02310555.
    1. Brunier G, Carson MG, Harrison DE. What do nurses know and believe about patients with pain? Results of a hospital survey. J Pain Symptom Manage. 1995;10:436–445. doi: 10.1016/0885-3924(95)00020-Y.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23:129–138.
    1. Dicle A, Karayurt O, Dirimese E. Validation of the Turkish version of the Brief Pain Inventory in surgery patients. Pain Manag Nurs. 2009;10:107–113. doi: 10.1016/j.pmn.2008.08.002.
    1. Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2010.
    1. Chaudakshetrin P. Validation of the Thai Version of Brief Pain Inventory (BPI-T) in cancer patients. J Med Assoc Thai. 2009;92:34–40.
    1. Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Validation of the brief pain inventory in patients six months after cardiac surgery. J Pain Symptom Manage. 2007;34:648–656. doi: 10.1016/j.jpainsymman.2007.01.010.
    1. Wennström B, Stomberg MW, Modin M, Skullman S. Patient symptoms after colonic surgery in the era of enhanced recovery--a long-term follow-up. J Clin Nurs. 2010;19:666–672. doi: 10.1111/j.1365-2702.2009.03099.x.
    1. Du Pen AR, Du Pen S, Hansberry J, Miller-Kraybill B, Millen J, Everly R, Hansen N, Syrjala K. An educational implementation of a cancer pain algorithm for ambulatory care. Pain Manag Nurs. 2000;1:116–128. doi: 10.1053/jpmn.2000.19333.
    1. Fränneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyrén O, Sandblom G. Validation of an Inguinal Pain Questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg. 2008;95:488–493.
    1. Sandblom G, Carlsson P, Sennfält K, Varenhorst E. A population-based study of pain and quality of life during the year before death in men with prostate cancer. Br J Cancer. 2004;90:1163–1168. doi: 10.1038/sj.bjc.6601654.
    1. Symptom Research - The Brief Pain Inventory - MD Anderson Cancer Center. Assessed 6th March 2011.
    1. Altman D. Practical statistics for medical research. 1. London; New York: Chapman and Hall; 1991.
    1. WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. Assessed 6th March 2011.
    1. SFS 2003:460. Swedish Act concerning the ethical review of research involving humans. Stockholm, The Ministry of Education and Cultural Affairs
    1. Swedish Personal Data Protection Act (1998:204) issued 29 April 1998.
    1. Richards D, Borglin G. Complex interventions and nursing: Looking through a new lens at nursing research. Int J Nurs Stud. 2011;48:531–533. doi: 10.1016/j.ijnurstu.2011.02.013.

Source: PubMed

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