Table 4.

Pain medication management interventions for family carers of patients with advanced cancer

First author, year, country	Intervention: format*, resources provided to carers, follow-up	Duration and intensity of intervention†	Provider, recipients, site of delivery.	Detail of intervention content theoretical basis
Ferrell, 1995, USA	3 Face-to-face interactive teaching sessions Printed instructions for drug and non-drug treatment Audiotapes of first 2 sessions US$50 for non-drug equipment Follow-up: 2 additional visits (only data collection?)	3 1 h sessions delivered over 2 weeks. Total duration 3 h Follow-up visits at 1 and 3 weeks after intervention: duration NR	Teaching sessions delivered by experienced specialist nurse in the patient's home to patient alone or patient and carer together	Pain education program with cognitive/behavioural components General information about pain, pain assessment and importance of pain relief Drug treatment and medication management Non-drug treatment of pain, including demonstrations, promotion of combining drug and non-drug approaches Caregivers were instructed on how to support the patient Theoretical basis: NR
Wells, 2003, USA	Single interactive education session: 15 min video followed by face-to-face discussion of content and patient's current medication Printed information on analgesics Follow-up: (1) patient given phone number for pain ‘hotline’ (no cost); (2) provider-initiated telephone calls; (3) usual care	Single session duration 20–30 min. Follow-up: no calls were made to the ‘hotline’. Provider-initiated weekly phone calls for 4 weeks, lasting 5–15 min. Total duration 20–60 min	Education session in hospital outpatient clinic; NR who delivered to patient and carer together. Video featured expert clinicians and patients. Follow-up phone calls: specialist oncology nurse, NR recipient (patient or carer)	Cognitive intervention. Video included information about pain, methods to control pain, opioids, low risk of addiction, side effects of pain meds, and emphasised the importance of communicating pain to providers Follow-up telephone calls: nurse-assessed patients’ understanding of pain medicines, asked about any problems Theoretical basis: NR
Keefe, 2005, USA	3 face-to-face interactive education/training sessions eliciting concerns and providing coaching to develop coping strategies Printed materials (book) Video and audio tapes	3×45–60 min sessions (average 56 min) delivered over 1–2 weeks (average 14 days, range 8–32 days) Total duration 2.25–3 h	Education/training sessions delivered by nurse educator in the patient's home to patient and carer together	Partner-guided pain management training provided Information on managing cancer pain, addressing specific concerns raised by participants Training in cognitive and behavioural pain-coping skills (relaxation and imagery, activity-rest cycle) using behavioural rehearsal procedure, including guiding partner to coach patient to acquire and maintain coping skills Feedback on use of methods and skills taught Help to devise a coping maintenance plan Theoretical basis: NR
Lin, 2006, Taiwan	Face-to-face session at which content of booklet presented. Questions elicited and answered. Participants encouraged to phone if questions arose Copy of booklet Follow-up: 2 face-to-face sessions, information reiterated and questions answered	Initial session 30–40 min.Follow-up at 2 and 4 weeks after initial session: duration NR	Intervention delivered by a researcher to patient and carer together in a private room in the hospital outpatient clinic	Cognitive intervention. Culturally specific booklet developed from earlier research into patient barriers to cancer pain management. Information addressed nine major concerns contributing to reluctance to report pain and use analgesics: fatalism, addiction, desire to be good, fear of distracting physicians, disease progression, tolerance, side effects, religious fatalism, and prn meds Theoretical basis: NR
Ward, 2009, USA	Single face-to-face interactive education session working through first 6 steps of 7-step intervention Follow-up: 2 telephone calls address 7th step	Initial session 20–80 min, depending on participant needs Follow-up phone calls at 2 and 4 weeks after initial session, lasting 5–10 min Total duration 30–100 min	Intervention delivered by specially trained nurse or psychologist at convenient location, usually the patient's home, to the patient alone or patient and carer together Follow-up phone calls: recipient (patient or caregiver) NR	RIDcancerPAIN+ was designed to elicit and understand patients’ representations of symptoms before providing new information and developing strategies for behaviour change in a 7-step process Exploration of beliefs about cancer pain Identification of misconceptions about pain and analgesia use Discussion of consequent limitations and losses Tailored information provision, filling gaps, etc Discussion of benefits of adopting new information Patient creates plan for changing how pain is managed Evaluation and revision of coping plans (follow-up) Theoretical basis: representational approach to patient education
Capewell, 2010, UK	2 education sessions: 6 min video shown, and printed information provided, any questions answered Copies of DVD and printed materials	Two sessions approximately 1 week apart. Duration NR	Video (featuring palliative care clinicians) shown in hospital outpatient clinic to patient alone or patient and carer together by researcher who answered questions	Brief structured educational intervention focusing on cancer pain and the use of strong opioids, emphasising that cancer pain can often be well controlled, importance of pain assessment and good communication. Addressed ‘common fears’ about opioids found in previous research Theoretical basis: NR
Vallerand, 2010, USA	Patients and carers Initial visit (face-to-face) given printed information; second visit face-to-face education session. Extent of interaction NR Nurses providing home care 2 lecture/discussion sessions Printed resources on pain management and opioid-related side effects	Patients and carers First contact duration NR. Education 1 week later, duration 1 h Nurses 1st teaching session 4 h 4–6 weeks to apply in practice 2nd teaching session duration NR	Patients and carers visited at home by PI or researcher; education session delivered by PI to patient alone or patient and carer together Nurses’ teaching delivered in classroom, NR by whom, and size of group	Power Over Pain: a structured educational intervention on management of pain and side effects in patients with cancer For patients and carers: importance of pain management; misconceptions; analgesics; side-effect management. Based on program for nurses, ‘presented at a level appropriate for the layman’ For nurses, 1st session: misconceptions about analgesics; pharma pain control and side effects; communicating with physicians and patients. 2nd session: ‘more advanced concepts’, ie, dose titration and managing side effects. Role play and assertiveness training to develop communication advocacy skills Theoretical basis: NR
Valeberg, 2013, Rustoen; 2012, Norway	3 face-to-face teaching sessions, interspersed with 3 telephone contacts Printed resources on pain and side effect management Weekly pill box Script to assist communication with physician re pain and medicines	Contact made every week for 6 weeks Duration of 3 home visits and 3 phone calls NR	Home visits and phone calls made by a specially trained oncology nurse, who delivered teaching sessions to patient alone, or patient and carer together. Phone calls: NR recipient (patient or caregiver)	Norwegian adaptation of PRO-SELF Pain Control Program, developed in USA. Psychoeducational pain management intervention to increase knowledge and change attitudes to pain management and use of medication. First teaching session addressed knowledge deficits (identified from Family Pain Questionnaire). Subsequent contacts reviewed pain scores and use of medication; reinforced education; and provided further coaching, eg, modifying pain management plans or contacting physicians Theoretical basis: NR

*Format: face-to-face, telephone calls, video presentation, printed materials.

†Duration and intensity: number and duration of sessions/phone calls; total duration of intervention and over what time period.

NR, not reported.