Educational interventions to improve cancer pain control: a systematic review.

CONTEXT Inadequate pain control is a dismaying reality in cancer patients. OBJECTIVES To review studies on cancer pain control interventions, and describe their findings with respect to participants' attitudes and knowledge, pain management, and pain levels. DATA SOURCES Computer searches were made in MEDLINE from January 1962, in PsychLIT from January 1974, and in CINAHL from January 1982 to August 1999, using a search strategy based on a combination of key words. STUDY SELECTION Computerized listings from these sources contained 383, 26, and 85 articles, respectively. After exclusion of duplicates, abstracts, editorials, letters, and irrelevant articles, we retained for review 33 articles, of which 25 (76%) were interventions targeting health professionals, and 8 (24%) interventions targeting patients and family caregivers. DATA EXTRACTION Study reports were reviewed using the following structured framework: Intervention Setting, Study Methods, Process Assessment, and Pain Outcome Assessment (Attitudes and Knowledge, Pain Management, and Pain Relief/Quality of Life). DATA SYNTHESIS AND CONCLUSION Educational interventions can successfully improve cancer pain knowledge and attitudes of health care professionals, but without having much impact on patients' pain levels. The most promising avenue for improving cancer pain control in ambulatory settings may be brief, nursing interventions targeting patients in combination with a daily pain diary. This review suggests that further progress may occur through incorporating a systematic and valid method of documenting daily fluctuation in pain levels, and ensuring that documented uncontrolled pain is followed rapidly by clinical reassessment and dose adjustment.