Table 4

Pain medication management interventions for family carers of patients with advanced cancer

First author, year, countryIntervention: format*, resources provided to carers, follow-upDuration and intensity of intervention†Provider, recipients, site of delivery.Detail of intervention content
theoretical basis
Ferrell, 1995, USA3 Face-to-face interactive teaching sessions
Printed instructions for drug and non-drug treatment
Audiotapes of first 2 sessions
US$50 for non-drug equipment
Follow-up: 2 additional visits (only data collection?)
3 1 h sessions delivered over 2 weeks. Total duration 3 h
Follow-up visits at 1 and 3 weeks after intervention: duration NR
Teaching sessions delivered by experienced specialist nurse in the patient's home to patient alone or patient and carer togetherPain education program with cognitive/behavioural components
  1. General information about pain, pain assessment and importance of pain relief

  2. Drug treatment and medication management

  3. Non-drug treatment of pain, including demonstrations, promotion of combining drug and non-drug approaches

Caregivers were instructed on how to support the patient
Theoretical basis: NR
Wells, 2003, USASingle interactive education session: 15 min video followed by face-to-face discussion of content and patient's current medication
Printed information on analgesics
Follow-up: (1) patient given phone number for pain ‘hotline’ (no cost); (2) provider-initiated telephone calls; (3) usual care
Single session duration 20–30 min. Follow-up: no calls were made to the ‘hotline’. Provider-initiated weekly phone calls for 4 weeks, lasting 5–15 min. Total duration 20–60 minEducation session in hospital outpatient clinic; NR who delivered to patient and carer together. Video featured expert clinicians and patients. Follow-up phone calls: specialist oncology nurse, NR recipient (patient or carer)Cognitive intervention. Video included information about pain, methods to control pain, opioids, low risk of addiction, side effects of pain meds, and emphasised the importance of communicating pain to providers
Follow-up telephone calls: nurse-assessed patients’ understanding of pain medicines, asked about any problems
Theoretical basis: NR
Keefe, 2005, USA3 face-to-face interactive education/training sessions eliciting concerns and providing coaching to develop coping strategies
Printed materials (book)
Video and audio tapes
3×45–60 min sessions (average 56 min) delivered over 1–2 weeks (average 14 days, range 8–32 days)
Total duration 2.25–3 h
Education/training sessions delivered by nurse educator in the patient's home to patient and carer togetherPartner-guided pain management training provided
  1. Information on managing cancer pain, addressing specific concerns raised by participants

  2. Training in cognitive and behavioural pain-coping skills (relaxation and imagery, activity-rest cycle) using behavioural rehearsal procedure, including guiding partner to coach patient to acquire and maintain coping skills

  3. Feedback on use of methods and skills taught

  4. Help to devise a coping maintenance plan

Theoretical basis: NR
Lin, 2006, TaiwanFace-to-face session at which content of booklet presented. Questions elicited and answered. Participants encouraged to phone if questions arose
Copy of booklet
Follow-up: 2 face-to-face sessions, information reiterated and questions answered
Initial session 30–40 min.Follow-up at 2 and 4 weeks after initial session: duration NRIntervention delivered by a researcher to patient and carer together in a private room in the hospital outpatient clinicCognitive intervention. Culturally specific booklet developed from earlier research into patient barriers to cancer pain management. Information addressed nine major concerns contributing to reluctance to report pain and use analgesics: fatalism, addiction, desire to be good, fear of distracting physicians, disease progression, tolerance, side effects, religious fatalism, and prn meds
Theoretical basis: NR
Ward, 2009, USASingle face-to-face interactive education session working through first 6 steps of 7-step intervention
Follow-up: 2 telephone calls address 7th step
Initial session 20–80 min, depending on participant needs
Follow-up phone calls at 2 and 4 weeks after initial session, lasting 5–10 min
Total duration 30–100 min
Intervention delivered by specially trained nurse or psychologist at convenient location, usually the patient's home, to the patient alone or patient and carer together
Follow-up phone calls: recipient (patient or caregiver) NR
RIDcancerPAIN+ was designed to elicit and understand patients’ representations of symptoms before providing new information and developing strategies for behaviour change in a 7-step process
  1. Exploration of beliefs about cancer pain

  2. Identification of misconceptions about pain and analgesia use

  3. Discussion of consequent limitations and losses

  4. Tailored information provision, filling gaps, etc

  5. Discussion of benefits of adopting new information

  6. Patient creates plan for changing how pain is managed

  7. Evaluation and revision of coping plans (follow-up)

Theoretical basis: representational approach to patient education
Capewell, 2010, UK2 education sessions: 6 min video shown, and printed information provided, any questions answered
Copies of DVD and printed materials
Two sessions approximately 1 week apart. Duration NRVideo (featuring palliative care clinicians) shown in hospital outpatient clinic to patient alone or patient and carer together by researcher who answered questionsBrief structured educational intervention focusing on cancer pain and the use of strong opioids, emphasising that cancer pain can often be well controlled, importance of pain assessment and good communication. Addressed ‘common fears’ about opioids found in previous research
Theoretical basis: NR
Vallerand, 2010, USAPatients and carers
Initial visit (face-to-face) given printed information; second visit face-to-face education session. Extent of interaction NR
Nurses providing home care
2 lecture/discussion sessions
Printed resources on pain management and opioid-related side effects
Patients and carers
First contact duration NR. Education 1 week later, duration 1 h
1st teaching session 4 h
4–6 weeks to apply in practice
2nd teaching session duration NR
Patients and carers visited at home by PI or researcher; education session delivered by PI to patient alone or patient and carer together
Nurses’ teaching delivered in classroom, NR by whom, and size of group
Power Over Pain: a structured educational intervention on management of pain and side effects in patients with cancer
For patients and carers: importance of pain management; misconceptions; analgesics; side-effect management. Based on program for nurses, ‘presented at a level appropriate for the layman’
For nurses, 1st session: misconceptions about analgesics; pharma pain control and side effects; communicating with physicians and patients. 2nd session: ‘more advanced concepts’, ie, dose titration and managing side effects. Role play and assertiveness training to develop communication advocacy skills
Theoretical basis: NR
Valeberg, 2013, Rustoen; 2012, Norway3 face-to-face teaching sessions, interspersed with 3 telephone contacts
Printed resources on pain and side effect management
Weekly pill box
Script to assist communication with physician re pain and medicines
Contact made every week for 6 weeks
Duration of 3 home visits and 3 phone calls NR
Home visits and phone calls made by a specially trained oncology nurse, who delivered teaching sessions to patient alone, or patient and carer together. Phone calls: NR recipient (patient or caregiver)Norwegian adaptation of PRO-SELF Pain Control Program, developed in USA. Psychoeducational pain management intervention to increase knowledge and change attitudes to pain management and use of medication. First teaching session addressed knowledge deficits (identified from Family Pain Questionnaire). Subsequent contacts reviewed pain scores and use of medication; reinforced education; and provided further coaching, eg, modifying pain management plans or contacting physicians
Theoretical basis: NR
  • *Format: face-to-face, telephone calls, video presentation, printed materials.

  • †Duration and intensity: number and duration of sessions/phone calls; total duration of intervention and over what time period.

  • NR, not reported.