Cancer Pain in Elders: Promoting EBPs in Hospices

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DESCRIPTION (provided by applicant): This study is an extension of our current research and focuses on promoting adoption of evidence-based practices (EBPs) to improve the quality of pain management for elder persons with cancer. The study addresses barriers to consistent adoption of pain management clinical practice guidelines for assessing and treating cancer pain in elders. These elders suffer needlessly from pain related to their cancer, its treatment, and related co morbid conditions. Despite existence of evidence-based guidelines to improve assessment and management of pain in this vulnerable population, adoption and use of recommendations based on best scientific evidence lags and is sporadic at best. Even in the hospice setting where pain control is a priority, there is considerable variation and patients still die in unresolved pain. A secondary barrier underlying effective pain management in this population is patient and family caregiver non-adherence to the pain treatment plan. Effective implementation of current Clinical Practice Guidelines (CPGs) that include evidence-based strategies for addressing this barrier may further contribute to improved quality of pain management for elders at the end of life. Translating Research into Practice (TRIP) is an active process of promoting use of evidence by healthcare providers that may improve pain management practices for elders with cancer pain. The proposed randomized control trial builds on our successful TRIP-Acute Pain intervention that demonstrated improved quality of acute pain management for hospitalized elders with hip fractures and savings of healthcare dollars. This study will evaluate the effect of an interdisciplinary multifaceted TRIP intervention focused on increasing EBPs for assessing and managing pain in elder hospice patients with cancer pain. The study aims are as follows: 1) Test the effect of a multifaceted TRIP-Cancer Pain intervention on pain severity, pain interference, pain relief and quality of life in elder hospice patients with cancer pain; 2) Test the effect of a multifaceted TRIP-Cancer Pain intervention on promoting adoption, by health care providers, of cancer pain management EBPs for elder hospice patients with cancer pain; 3) Determine the effectiveness of a multifaceted TRIP-Cancer Pain intervention on patient adherence to the pain treatment plan; and 4) Evaluate the persistence of change in process and outcome variables at long-term follow-up (6 months post intervention).