Lisa Lewis

Background: Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design: The Cancer Health Empowerment for Living without Pain Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity or pain-related impairment were randomly assigned to receive tailored education and coaching or educationally-enhanced usual care ; 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components. Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion: Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment ; self-efficacy and quality of life ; and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. © 2009 Kravitz et al; licensee BioMed Central Ltd.