Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain
1 Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California, USA
2 Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, California, USA
3 Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA
4 Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, California, USA
5 Kaiser Permanente, Northern California, California, USA
6 UCD Cancer Center, Sacramento, California, USA
7 Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, CA, USA
8 Department of Communications, Texas A & M University, College Station, TX, USA
BMC Cancer 2009, 9:319 doi:10.1186/1471-2407-9-319Published: 9 September 2009
Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes.
The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks.
Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost.
[Clinical Trials Identifier: NCT00283166]