CANCER PAIN MANAGEMENT IN COMMUNITY BASED RURAL SETTINGS

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The purpose of the current proposal is to develop a Multi-Component Intervention designed to improve cancer pain management for outpatients receiving care in rural, community-based settings. The Multi-Component Intervention will target health care professional, patient / family- related, and systems barriers to treatment and will include: l) a cancer pain education program for health care professionals utilizing interactive media technology; 2) a patient and family education program; 3) an office facilitator who will provide tools and a reminder system to enhance cancer pain management in the physicians' office; and 4) a Pain Relief Network consisting of a hotline to pain experts at the Dartmouth-Hitchcock Medical Center to provide consultation and ongoing role modeling to health care professionals and patients. Following program development, an outcome study will be conducted which will consist of a randomized trial where physician practices will be assigned to receive the Multi-Component Intervention or Usual Dissemination of AHCPR Clinical Practice Guidelines for Cancer Pain Management Patients will be assessed prior to the intervention and followed longitudinally post-intervention. Patient outcomes will be assessed utilizing measures of pain-related variables (Brief Pain Inventory and pain and medication logs), quality of life measures (Functional Assessment of Cancer Therapy-General, Brief Profile of Mood States, Symptom Distress Scale), and patient barriers to pain management (Barriers Questionnaire). Practice compliance with AHCPR Guidelines for cancer pain management will be assessed through record review, Patient Outcome Questionnaire and knowledge and attitude questionnaires. The randomized trial is designed to test two primary hypotheses: l) Patients treated by practice groups receiving the Multi- Component Intervention will report better pain management and higher quality of life compared to patients treated by practice groups in the Usual Dissemination Intervention and 2) Practice groups exposed to the Multi-Component Intervention will demonstrate a closer compliance with the AHCPR guidelines for the treatment of cancer pain as determined by record review and patient outcome questionnaire compared to the practice groups that receive the Usual Dissemination Intervention. Secondarily, we predict that: l)Patients treated by practice groups that closely comply with the AHCPR Guidelines will report better pain management and higher quality of life compared to practice groups that have a low level of compliance and 2) Improvement in pain management and higher quality of life reported by patients will be associated with a reduction in patient concerns regarding pain management.