IMPROVING CANCER PAIN MANAGEMENT IN COMMUNITIES - MAIN RESULTS FROM ARANDOMIZED CONTROLLED TRIAL

The purpose of this randomized controlled community trial is to evalua te the effects of a community intervention utilizing opinion lenders a nd educational strategies on the cancer pain management Knowledge, att itudes, and the practices of physicians and nurses, and cancer pain re ported by patients. Six Minnesota communities participated in the stud y. The three communities randomized to the intervention received educa tional programs over 15 months. The clinical community opinion leaders participated in a minifellowship, developed community task forces, an d interacted with their peers. This strategy was reinforced with commu nity outreach programs, clinical practice guidelines, educational mate rials, and media events. The primary study end point was patients' pai n intensity score. Comparing intervention to control communities, pain prevalence declined slightly, pain management index improved slightly , pain intensity scores increased slightly, patient and family attitud e scores did not change, and physicians' and nurses' knowledge and att itude scores improved slightly. None of these changes, however, reache d statistical significance. Participation in at least one intervention program improved physicians' and nurses' knowledge and attitude score s that approached statistical significance. Our results suggest that c ommunity opinion lenders combined with other educational programs may improve cancer pain management, but this strategy requires further stu dy. The results suggest that more intense intervention application may be effective. Effective strategies to improve cancer pain management remain elusive. (C) U.S. Cancer Pain Relief Committee, 1997.