A Randomized Trial of a Representational Intervention for Cancer Pain: Does Targeting the Dyad Make a Difference?

Objective: To determine the efficacy in overcoming attitudinal barriers to reporting cancer pain and using analgesics of an educational intervention presented to patients accompanied by a significant other (SO) as compared with patients alone. Design: Patient-SO pairs (N = 161) were randomized to the dyad condition (patient and SO received the intervention), solo condition (patient received the intervention), or care as usual. Dyad and solo conditions received the intervention at baseline (T1) and 2 and 4 weeks later. Main Outcome Measures: Patients' and SOs' attitudes about analgesic use and patients' pain outcomes (pain severity, pain relief, interference with life, negative mood, and global quality of life [QOL]) at T1, 5 weeks later (T2), and 9 weeks later (T3). Results: Completers' analyses revealed no significant differences between groups at T2. At T3, patients in the dyad and the solo groups showed greater decreases in attitudinal barriers as compared with controls. T1-T3 changes in patients' barriers mediated between the dyad and solo interventions and pain severity, pain relief, pain interference, negative mood, and global QOL. Conclusion: The intervention was no more efficacious when it was presented to dyads than to patients alone. Conditions under which SOs should be included in interventions need to be determined.