The Use of a Digital Application for Reporting Pain and Pain Management in Home Hospice (ePainSupport)

Rush

Status: Completed

Conditions: Pain

Treatments: Behavioral: e-PainSupport

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04869085

310243 (Other Identifier)

5R21NR018952 (U.S. NIH Grant/Contract)

310244 (Other Identifier)

310245 (Other Identifier)

19111205-IRB01

Details and patient eligibility

About

Poor adherence to pain management and high pain intensity associated with serious, advanced illness is a major public health concern. This randomized clinical trial will test the efficacy of a newly enhanced digital pain and pain management application (e-PainSupport) for use in a home hospice setting. The e-PainSupport application delivers an education module about pain management to patients and caregivers, expedites pain reporting to nurses, and facilitates adherence to pain management. The overall goal of the e-PainSupport application is to improve pain management and reduce patient pain intensity in the home hospice setting.

Full description

High pain intensity is a common symptom experienced by patients with serious advanced illness. However, pain management for patients in home hospice is less than optimal. Impediments to improving pain intensity are poor adherence to pain management regimen due in part to caregiver lack of knowledge (a barrier to reporting pain and using analgesics) and lack of self-efficacy (confidence) in administering analgesics. Digital applications may facilitate pain management by: (1) delivering education to increase knowledge and self-efficacy, (2) expediting pain reporting to nurses, and (3) improving adherence to pain management. e-PainSupport is a self-administered, digital pain management application developed in collaboration with hospice nurses and caregivers. It is directly linked to a patient's medical record and enhanced by an evidence-based educational module. It has three elements: (a) Educational Module, (b) Patient Pain Record, and (c) Pain Summary for Nurses. The purpose of this study is to test the effects of e-PainSupport on home hospice patient pain intensity when used by patients, caregivers and nurses. Participants (132 triads of patient, caregiver, and the hospice nurse assigned to the patient will be recruited from one large Midwest hospice agency. Patient and caregiver outcomes will be assessed at baseline and 2 weeks post baseline. Data will be analyzed with multi-level modeling. Post-intervention semi-structured interviews will be conducted with nurses who provided care to patients in the e-PainSupport condition. Qualitative content analysis will be used to identify themes related to perceived practice changes after using e-PainSupport. e-PainSupport has potential as a useful tool to advance home hospice care by enhancing the quality of caregiver pain management, facilitating nurse-patient communication, and improving management of patient pain intensity.

Enrollment: 124 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria (patient)

• prior enrollment of their hospice nurse
• receives analgesics for pain
• speaks and reads English
• age 18 or older
• has a primary informal caregiver who is available for the 2 weeks of the study
• expected survival of at least 2 weeks
• can verbalize pain.

Inclusion criteria (caregiver)

• speaks and reads English
• age 18 or older
• cares for an enrolled patient
• available for the 2 weeks of the study.

Inclusion criteria (nurses participating in the RTC)

• registered nurse (RN)
• provides direct care to patients
• has not had a prior patient enrolled in the study

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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124 participants in 2 patient groups

e-PainSupport Condition

Experimental group

Description:

e-PainSupport is a self-administered, digital pain application. Over the course of the two weeks, caregivers and patients will record the severity of patient's pain and how much pain medicine they use to control patient's pain in the e-PainSupport application.

Treatment:

Behavioral: e-PainSupport

Standard Care Condition

No Intervention group

Description:

Patients and caregivers will be given a paper copy of the same list of resources for pain management included in the Education Module of the e-PainSupport condition at baseline.