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Partnering to cope with pain: A pilot study of a caregiver-assisted pain coping skills intervention for patients with cognitive impairment and dementia

Published online by Cambridge University Press:  04 November 2021

Laura S. Porter*
Affiliation:
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
Debra K. Weiner
Affiliation:
Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
Katherine Ramos
Affiliation:
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
Deborah E. Barnes
Affiliation:
University of San Francisco, UCSF Weill Institute for Neurosciences, San Francisco, CA
Kenneth E. Schmader
Affiliation:
Department of Medicine, Duke University School of Medicine and GRECC, Durham VA Medical Center, Durham, NC
Lisa Gwyther
Affiliation:
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
Christine S. Ritchie
Affiliation:
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA
Francis J. Keefe
Affiliation:
Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC
*
Author for correspondence: Laura S. Porter, DUMC Box 90399, Durham, NC 27710, USA. E-mail: [email protected]

Abstract

Objective

To develop a new caregiver-assisted pain coping skills training protocol specifically tailored for community-dwelling persons with cognitive impairment and pain, and assess its feasibility and acceptability.

Method

In Phase I, we conducted interviews with 10 patient–caregiver dyads to gather feedback about intervention content and delivery. Phase II was a single-arm pilot test to evaluate the intervention's feasibility and acceptability. Dyads in the pilot study (n = 11) completed baseline surveys, received five intervention sessions, and then completed post-intervention surveys. Analyses focused on feasibility and acceptability.

Results

Dyads responded positively to the pain coping skills presented in the interviews; their feedback was used to refine the intervention. Findings from the pilot study suggested that the intervention was feasible and acceptable. 69% of eligible dyads consented, 82% completed all five intervention sessions, and 100% completed the post-treatment assessment. Caregivers reported high satisfaction ratings. They also reported using the pain coping skills on a regular basis, and that they found most of the skills helpful and easy to use.

Significance of results

These preliminary findings suggest that a caregiver-assisted pain coping skills intervention is feasible and acceptable, and that it may be a promising approach to managing pain in patients with cognitive impairment.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Achterberg, WP, Pieper, MJ, van Dalen-Kok, AH, et al. (2013) Pain management in patients with dementia. Clinical Interventions in Aging 8, 14711482. doi:10.2147/cia.s36739CrossRefGoogle ScholarPubMed
Alzheimer's Association (2020) 2020 Alzheimer's disease facts and figures. Alzheimer's and Dementia 15, 391460. doi:10.1002/alz.12068Google Scholar
Barnes, DE, Mehling, W, Wu, E, et al. (2015) Preventing loss of independence through exercise (PLIÉ): A pilot clinical trial in older adults with dementia. PLoS One 10(2), e0113367. doi:10.1371/journal.pone.0113367CrossRefGoogle ScholarPubMed
Bradford, A, Shrestha, S, Snow, AL, et al. (2012) Managing pain to prevent aggression in people with dementia: A nonpharmacologic intervention. American Journal of Alzheimer's Disease & Other Dementias 27(1), 4147. doi:10.1177/1533317512439795CrossRefGoogle ScholarPubMed
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77101. doi:10.1191/1478088706qp063oaCrossRefGoogle Scholar
Casey, JJ, Harrison, KL, Ventura, MI, et al. (2020) An integrative group movement program for people with dementia and care partners together (Paired PLIÉ): Initial process evaluation. Aging and Mental Health 24(6), 971977. doi:10.1080/13607863.2018.1553142CrossRefGoogle ScholarPubMed
Chiao, CY, Wu, HS and Hsiao, CY (2015) Caregiver burden for informal caregivers of patients with dementia: A systematic review. International Nursing Review 62(3), 340350. doi:10.1111/inr.12194CrossRefGoogle ScholarPubMed
Corbett, A, Husebo, BS, Achterberg, WP, et al. (2014) The importance of pain management in older people with dementia. British Medical Bulletin 111(1), 139148. doi:10.1093/bmb/ldu023CrossRefGoogle ScholarPubMed
Daut, RL, Cleeland, CS and Flanery, RC (1983) Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 17, 197210. doi:10.1016/0304-3959(83)90143-4CrossRefGoogle ScholarPubMed
Eldridge, SM, Lancaster, GA, Campbell, MJ, et al. (2016) Defining feasibility and pilot studies in preparation for randomized controlled trials: Development of a conceptual framework. PLoS One 11(3), e0150205. doi:10.137/journal.pone/0150205CrossRefGoogle ScholarPubMed
Feldt, KS (2020) The checklist of nonverbal pain indicators (CNPI). Pain Management Nursing, 1321. doi:10.1053/jpmn.2000.5831Google Scholar
Gil, KM, Ross, SL and Keefe, FJ (1988) Behavioral treatment of chronic pain: Four pain management protocols. In France, RD & Krishnan, KRR (eds.), Chronic Pain. New York: American Psychiatric Press, pp. 376413.Google Scholar
Harrison, KL, Ritchie, CS, Patel, K, et al. (2019) Care settings and clinical characteristics of older adults with moderately severe dementia. Journal of the American Geriatric Society 67(9), 19071912. doi:10.1111/jgs.16054CrossRefGoogle ScholarPubMed
Hebert, LE, Weuve, J, Scherr, PA, et al. (2013) Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology 80(19), 17781783. doi:10.1212/WNL.0b013e31828726f5CrossRefGoogle ScholarPubMed
Hérbert, R, Bravo, G and Préville, M (2000) Reliability, validity, and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Canadian Journal on Aging 19, 494507.CrossRefGoogle Scholar
Hoffmann, F, van den Bussche, H, Wiese, B, et al. (2014) Diagnoses indicating pain and analgesic drug prescription in patients with dementia: A comparison to age- and sex-matched controls. BMC Geriatrics 14, 20. doi:10.1186/1471-2318-14-20CrossRefGoogle ScholarPubMed
Hsieh, HF and Shannon, SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9), 12771288. doi:10.1177/1049732305276687CrossRefGoogle ScholarPubMed
Hunt, LJ, Covinsky, KE, Yaffe, K, et al. (2015) Pain in community-dwelling older adults with dementia: Results from the national health and aging trends study. Journal of the American Geriatrics Society 63(8), 15031511. doi:10.1111/jgs.13536CrossRefGoogle ScholarPubMed
Husebo, BS and Corbett, A (2014) Dementia: Pain management in dementia–the value of proxy measure. Natures Review Neurology 10(6), 313314. doi:10.1038/nrneurol.2014.66CrossRefGoogle Scholar
Husebo, BS, Achterberg, W and Flo, E (2016) Identifying and managing pain in people with Alzheimer's disease and other types of dementia: A systematic review. CNS Drugs 30(6), 481497. doi:10.1007/s40263-016-0342-7CrossRefGoogle ScholarPubMed
Keefe, FJ, Caldwell, DS, Baucom, D, et al. (1996) Spouse-assisted coping skills training in the management of osteoarthritic knee pain. Arthritis Care & Research 9(4), 279291.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Keefe, FJ, Caldwell, DS, Baucom, D, et al. (1999) Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: Long-term followup results. Arthritis Care & Research 12(2), 101111.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Keefe, FJ, Ahles, TA, Sutton, L, et al. (2005) Partner-guided cancer pain management at the end of life: A preliminary study. Journal of Pain and Symptom Management 29(3), 263272. doi:10.1016/j.jpainsymman.2004.06.014CrossRefGoogle ScholarPubMed
Keefe, FJ, Porter, L, Somers, T, et al. (2013) Psychosocial interventions for managing pain in older adults: Outcomes and clinical implications. British Journal of Anaesthesia 111(1), 8994. doi:10.1093/bja/aet129CrossRefGoogle ScholarPubMed
Kraemer, HC, Mintz, J, Noda, A, et al. (2006) Caution regarding the use of pilot studies to guide power calculations for study proposals. Archives of General Psychiatry 63(5), 484489. doi:10.1001/archpsyc.63.5.484CrossRefGoogle ScholarPubMed
Lawton, MP, Kleban, MH, Moss, M, et al. (1989) Measuring caregiving appraisal. The Journals of Gerontology 44(3), 6171.CrossRefGoogle ScholarPubMed
Logsdon, RG, Gibbons, LE, McCurry, SM, et al. (2002) Assessing quality of life in older adults with cognitive impairment. Psychosomatic Medicine 64, 510519.CrossRefGoogle ScholarPubMed
Lorig, K, Chastain, RL, Ung, E, et al. (1989) Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatism 32(1), 3744.CrossRefGoogle ScholarPubMed
McConnell, T, Scott, D and Porter, S (2016) Music therapy for end-of-life care: An updated systematic review. Palliative Medicine 30(9), 877883. doi:10.1177/0269216316635387CrossRefGoogle Scholar
Mehling, W E, Scott, T M, Duffy, J, et al. (2020) Dyadic group exercises for persons with memory deficits and care partners: Mixed-method findings from the paired preventing loss of independence through exercise (PLIÉ) randomized trial. Journal of Alzheimer’s Disease 78(4), 16891706. doi:10.3233/JAD-200713CrossRefGoogle ScholarPubMed
Nguyen, TD, Attkisson, CC and Stegner, BL (1983) Assessment of patient satisfaction: Development and refinement of a service evaluation questionnaire. Evaluation and Program Planning 6, 299314. doi:10.1016/0149-7189(83)90010-1CrossRefGoogle ScholarPubMed
Niknejad, B, Bolier, R, Henderson, CRJ, et al. (2018) Association between psychological interventions and chronic pain outcomes in older adults: A systematic review and meta-analysis. JAMA Internal Medicine 78(6), 830839. doi:10.1001/jamainternmed.2018.0756CrossRefGoogle Scholar
Norelli, LJ and Harju, SK (2008) Behavioral approaches to pain management in the elderly. Clinics of Geriatric Medicine 24(2), 335344. vii. doi:10.1016/j.cger.2007.12.010CrossRefGoogle ScholarPubMed
Pieper, MJ, van Dalen-Kok, AH, Francke, AL, et al. (2013) Interventions targeting pain or behaviour in dementia: A systematic review. Ageing Research Reviews 12(4), 10421055. doi:10.1016/j.arr.2013.05.002CrossRefGoogle ScholarPubMed
Porter, LS, Keefe, FJ, Garst, J, et al. (2011) Caregiver-assisted coping skills training for lung cancer: Results of a randomized clinical trial. Journal of Pain and Symptom Management 41(1), 113. doi:10.1016/j.jpainsymman.2010.04.014CrossRefGoogle ScholarPubMed
Sangha, O, Stucki, G, Liang, MH, et al. (2003) The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis Care and Research 49(2), 156163. doi:10.1002/art.10993CrossRefGoogle ScholarPubMed
Shega, JW, Hougham, GW, Stocking, CB, et al. (2006) Management of noncancer pain in community-dwelling persons with dementia. Journal of the American Geriatrics Society 54(12), 18921897. doi:10.1111/j.1532-5415.2006.00986.xCrossRefGoogle ScholarPubMed
Warden, V, Hurley, AC and Volicer, L (2003) Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association 4, 915. doi:10.1097/01.JAM.0000043422.31640.F7CrossRefGoogle ScholarPubMed
Wu, E, DE, Barnes, SL, Ackerman, et al. (2015) Preventing Loss of Independence through Exercise (PLIÉ): qualitative analysis of a clinical trial in older adults with dementia. Aging and Mental Health 19(4), 353362. doi:10.1080/13607863.2014CrossRefGoogle ScholarPubMed
Zarit, SH, Reever, KE and Bach-Peterson, J (1980) Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist 20(6), 649655.CrossRefGoogle ScholarPubMed