Effectiveness of a pain education programme in cancer pain management: Results from the EFFADOL stepped-wedge trial.

Abstract

Pain remains undertreated in 40% of cancer patients with an impact on their quality of life. This study assessed the effectiveness of a Pain Education Programme (PEP) in improving cancer pain management. PEP was evaluated through a stepped-wedge pragmatic trial led in 6 independent clusters to compare usual pain care (before staff training) with the educational approach (after training). PEP was delivered in three 2-hour workshops dealing with understanding of pain, managing its treatment, and coping in daily life. The main endpoint was pain interference with daily life. Patients' adherence to PEP, worst pain intensity, anxiety, analgesic adherence, and educational effect of the PEP were evaluated. Among 145 assessable patients, no significant differences were observed in scores of pain interference with daily life between the 2 groups, who experienced substantial improvement. Similarly, worst pain intensity was reduced in both groups, with no added value after the PEP. In the PEP group, intervention significantly improved anxiety (p = 0.009), communication with health professionals (p = 0.028), and patients' knowledge of treatment (98.3% of them vs 88.1%). We found high levels of adherence to the PEP (80%), satisfaction and patients' feelings of having acquired skills in managing their pain after the PEP (>50% of patients rated scores >8.9 on a 0-10 scale). No additional benefit of the PEP vs usual care regarding pain interference with daily life was demonstrated. Beyond the fact that patients greatly appreciated the PEP, acquiring skills to better manage their pain and improving communication with health professionals were in line with the goal of therapeutic education. The PEP we applied took into account the French regulatory context concerning the implementation of therapeutic education. This process, although its benefits remain difficult to demonstrate, could enable patients to develop skills to better manage their pain. ClinicalTrials.gov Identifier: NCT03297723, registered on 28, September 2017. (https://clinicaltrials.gov/study/NCT03297723).