Caregiver-guided pain management for patients with advanced cancer

Abstract

Background: Pain is a major concern of patients with advanced cancer and their family caregivers. Pain coping skills training (PCST) has been found efficacious with other populations but has rarely been tested in patients with advanced cancer. This study aims examines the efficacy of a caregiver-guided PCST intervention to improve caregiver and patient outcomes. Methods: In this multisite RCT, 236 patient-caregiver dyads are randomized to receive (a) caregiver-guided PCST, or (b) standard pain education. Assessments are conducted with patients and caregivers before randomization and post- treatment. Caregiver assessments also occur 3 and 6 months after the patient’s death. Measures include self-efficacy for pain management, pain severity and interference, psychological distress, and caregiver strain and satisfaction. Expected results: We hypothesize that the intervention will lead to significant improvements in caregiver self-efficacy. Secondary hypotheses: the intervention will lead to improvements in caregiver adjustment (short-term and post-death), and patient outcomes (self-efficacy, pain, psychological distress). Current stage of work: 81 dyads are enrolled, 73 randomized, and 52 have completed post-treatment assessments. Challenges to enrollment have included identifying patients with advanced cancer and pain. The original inclusion criterion of <12 month life expectancy was dropped, and research staff received additional training in pain assessment methods. Discussion: A PCST intervention has promise for alleviating suffering of patients with advanced cancer and their caregivers. Conducting a behavioral intervention in this population poses specific challenges. Lessons learned from this study can be applied to future trials evaluating behavioral interventions for patient-caregiver dyads in the palliative care setting.