Effects of self-management interventions for cancer patients with pain: A systematic review of randomised controlled trials

Abstract

Aims: To evaluate the effects of self-management interventions targeting individuals with cancer-related pain on pain intensity, self-efficacy, quality of life (QoL), pain medication adherence, and pain-related knowledge and provide recommendations for the content and format of self-management interventions based on the existing evidence. Design: A systematic review of randomised controlled trials (RCTs) and narrative synthesis. Data Sources: A search of six electronic databases, including Medline, PsycINFO, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Review Methods: This systematic review followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from January 2011 to March 2022 in English were retrieved. The Cochrane Risk of Bias Tool was used to assess quality. Data were summarised using narrative synthesis. Results: This systematic review included six RCTs involving 748 patients with cancer-related pain. The results support the effectiveness of the intervention on QoL and pain-related knowledge. Mixed results were observed in the effectiveness on pain intensity, self-efficacy and medication adherence. Overall, the quality of the evidence was low. The content of self-management interventions varied across studies but with similar formats (face-to-face coaching and telephone follow-up). Conclusion: The existing evidence supports the effectiveness of self-management interventions on pain-related knowledge and QoL. Further high-quality RCTs are needed to determine the most effective interventions. Relevance to Clinical Practice: Self-management is recommended to improve cancer patients' pain awareness, self-management behaviour and adaptability. Components for self-management of cancer pain, including patient attitude and knowledge assessment, nurse coaching and counselling, reinforcement during follow-up period, and provision of supplementary materials on pain management and medication adherence, could be covered in the intervention. In the future, it is worthwhile exploring an effective intervention using Internet-based information technology, for example WeChat, to aid the delivery of self-management intervention. No Patient or Public Contribution: This systematic review does not necessarily involve patients or public members in this work.