Cancer Pain and Symptom Management
Unrelieved cancer pain and fatigue are major health problems. We propose a randomized clinical trial with pre-test/ post-test measures in 326 patients with cancer to compare effects of usual-care and the computerized tool on symptom resolution and patient-centered communication during clinic visits. The computerized tool includes electronic versions of three valid and reliable scales for pain and fatigue (Symptom Report) and cognitive-behavioral education interventions customized for patients (SymtomConsult). The specific aims are to 1) evaluate the feasibility of using the SymptomReport-SymptomConsult tool in an outpatient oncology setting with a diverse sample of 50 cancer patients receiving radiation. We hypothesize that the average patient will complete the tool in 20-30 minutes, provide answers to more than 80% of the items, and report the program as an acceptable way to report symptom information and receive self-care information; and 2) compare usual-care and the computerized tool for effects on: a) patient outcomes (pain and fatigue intensity, pain quality, satisfaction with pain and fatigue level, misconceptions about pain, exercise levels) in a diverse sample of 276 persons receiving radiation therapy; b) provider outcomes (number of treatments suggested for pain and fatigue; clinic visit length) in a sample of radiation oncologists; and c) patient-provider partnership outcomes (ratio of provider-centered to patient-centered talk during audiotaped clinic visits). We hypothesize that the length of the clinic visit will be the same for the two groups but that the experimental group will report decreased scores for the intensity of their current and worst pain and fatigue, the MPQ pain quality subscales, ratio of provider-centered to patient-centered talk during clinic visits; and increased levels of satisfaction with pain and fatigue levels, exercise levels, number of fatigue or pain prescriptions. Patients will either complete usual assessments or use a new computerized tool. In the experimental group, the SymptomReport data will be used to provide a summary of the symptoms and to proved a SymptomConsult to patients. The interaction between the patient and the provider during routine clinic visits will be audiotaped and analyzed for types of communication during the visit. Four weeks after the pre-test (peak of their cancer symptoms), patients will complete the computerized assessment tool document outcomes. In this project the student will gain clinical experience at the cancer study by observing the collection of data with the use of pentabs and the student will participate in coding and scoring the tapes obtained from the routine clinic visits. Study findings will be used to guide revisions of the tool and to plan future studies to implement this new cancer control technology for improved health communications and symptom management.
