Herr, K., Titler, M., Fine, P.G., Sanders, S., Cavanaugh, J.E., Swegle, J., . . . Forcucci, C. (2012). The effect of a translating research into practice (TRIP)-cancer intervention on cancer pain management in older adults in hospice. Pain Medicine, 13, 1004–1017.
DOI Link
Study Purpose
To promote the adoption of evidence-based pain practices for older adults with cancer
Intervention Characteristics/Basic Study Process
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Five-month engagement phase—receipt of three relevant clinical practice guidelines for experimental (E) and control (C) groups, pain training and activities for E hospices
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12-month implementation phase—E group received tools for implementation (e.g., quick reference guides), nurses completed an evidence-based practice (EBP) pain program, sites received a monthly outreach visit from an expert nurse who audited charts for 48 EBP indicators and provided feedback, participation in a monthly teleconference to discuss progress and strategies, sharing on e-sites, weekly pain assessment and management sessions as desired
Sample Characteristics
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N = 16 hospices and 738 patients
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AGE: Hospices see 30 older patients per year; patients were older adults with a mean age of 77.6 years
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MALES: 55.9%, FEMALES: 44.1%
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KEY DISEASE CHARACTERISTICS: End-stage cancer
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OTHER KEY SAMPLE CHARACTERISTICS: 66.3% white
Setting
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SITE: Multi-site
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SETTING TYPE: Home
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LOCATION: Midwest hospices
Phase of Care and Clinical Applications
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PHASE OF CARE: End-of-life care
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APPLICATIONS: Elder care
Study Design
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Retrospective, cluster, randomized control trial of 16 hospices
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Eight in the E group and eight in the C group
Measurement Instruments/Methods
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Cancer Pain Practice Index (CPPI), which lists 11 EBP cancer pain practices for older adults
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Mean pain severity
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Medical record abstract tool inclusive of 48 indicators of EBP for pain management
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Numeric Rating Scale
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Pain severity scale (0–10)
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Verbal Descriptor Scale for pain intensity (mild, moderate, severe)
Results
No significant differences existed between the E and C groups in regards to improvement in the CPPI. A decrease in pain severity was found from baseline to post-intervention in the E group, but this was not statistically significant.
Conclusions
Numerous factors influence a multicomponent intervention. Culture, competing priorities, intervention complexity, and other factors may have a role. Future studies should focus on more specific factors in need of change. Although the patient sample was large, only eight hospices comprised each group for the study.
Limitations
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Small sample (less than 30)
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Intervention expensive, impractical, or training needs
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Other limitations/explanation: The sensitivity of the CPPI to detect change in provider practice was not established a priori.
Nursing Implications
Translating research into practice is a primary goal of nursing, and pain guideline translation is essential to improving pain outcomes. Translation, however, takes time and may not translate immediately to improved patient outcomes.