Improving Pain Self-Management Among Rural, Older Cancer Patients

A recent study published in Jama Network found that an intervention called Cancer Health Empowerment for Living without Pain (CA-HELP) was well-received and feasible among older adults with cancer living in rural areas. The study reported high enrollment and completion rates, significant improvements in patients' pain management, confidence in discussing pain with doctors, decreased misconceptions about pain, and self-reported reduction in pain levels.

Megan Shen, Ph.D., from the Fred Hutchinson Cancer Center, and colleagues reported that the management of pain in older adults with cancer remains a significant public health concern and an unmet medical need, particularly in rural areas. This demographic often encounters specific challenges, such as limited access to healthcare services, hesitancy to talk about pain, and misunderstandings about pain management. With the backdrop of the opioid crisis and the unique challenges faced by this population, the importance of novel pain mitigation interventions cannot be overstated.

CA-HELP was not originally designed for older adults nor rural populations. However, the study used the Method for Program Adaptation through Community Engagement to ensure that the adapted version, CA-HELP-A, meets the specific needs of this demographic. This involved connecting with older adult patients, caregivers, and healthcare professionals to identify barriers and tailor the intervention, a collaborative approach ensures that all participants’ perspectives are included in the process.

The CA-HELP-A intervention is not just a concept, but a well-founded strategy based on evidence. It is designed to empower and engage older adults with cancer to communicate effectively with their physicians about pain. The adapted version of CA-HELP used in the study included a workbook for patients and a coaching call with a registered nurse to educate the patients on pain management and communication techniques. An evidence-based approach, it reassures the participants about the intervention's effectiveness.

The study included thirty older adults aged 65 and older with cancer living in noninstitutional rural settings in Tennessee were enrolled in the study in May 2022. They received the CA-HELP-A intervention, which consisted of an 18-page patient workbook and a 30-minute coaching call. Assessments were carried out at baseline and one week after the intervention, focusing on pain self-management, self-efficacy, patient-reported pain and misconceptions about pain.

CA-HELP-A was designed to be neutral regarding pain intervention type, allowing for discussions about various pain management approaches, including both medication (such as opioids) and non-medication treatments.

While the study's focus was on pain self-management, secondary outcomes examined self-efficacy in communicating with physicians about pain, pain misconceptions, and patient-reported pain. Pain self-management was measured using the Chronic Pain Self-Efficacy scale, with patients rating their certainty about their ability to manage their pain on a 5-point Likert scale.

The results highlighted significant improvements across various outcomes, including intervention exhibited high feasibility rates, with 100% completion of intervention sessions and study procedures. Participants rated the intervention highly regarding helpfulness and satisfaction, with 80% deeming it "very helpful."

There were also notable changes in pain-related outcomes. Self-efficacy for communicating with physicians about pain increased. In addition, participants reported reductions in patient-reported pain and misconceptions regarding pain management.

The results of this initial study show that the modified CA-HELP-A intervention successfully improved communication about pain management among older individuals with cancer in rural areas. A focus on customizing the intervention to address the unique requirements of this demographic has proven to be effective in bringing about substantial improvements in pain-related issues.

Shen adds, “Our study shows that a 30-minute coaching session can help older adults going through cancer treatment to communicate their pain with their doctor. It educates them on cancer pain and pain management, helps them identify the type of pain they have, and helps them practice actual questions or conversations points they will bring to their clinical encounters. Perhaps most critical to our findings is that many older adults accept pain as part of aging in their day-to-day life, which may lead to them underreporting their pain and having it not properly managed. The brevity of this intervention, combined with how potentially effective it could be, could be an excellent step in support older adults with cancer in managing their pain and suffering less.

Takeaways and recommendations from our study for patients is to mention any pain you are experiencing, especially if it began after their cancer diagnosis and/or treatment. Your doctor wants to help you manage your pain. Takeaways from our study for providers is to probe or assess pain regularly, especially among older adults who may not be reporting it to you. Inquire as to what type of pain and how severe it is to get accurate results."