Improving pain management knowledge among hospice family caregivers: A randomized controlled trial.

Abstract

12032 Background: Poor pain management in home hospice settings is often due to family caregivers not adhering to analgesic regimens. Healthcare technology, like digital applications, can improve caregivers' access to education and communication with nurses, though it has been underutilized in home hospice. We developed and tested a digital pain management app called e-PainSupport in an NIH-funded randomized controlled trial with 44 hospice patient and caregiver dyads. The purpose of this study was to examine mediating effects of caregiver pain management knowledge on change in pain intensity, controlling for study condition and patient gender. Methods: We developed and tested a digital pain management app called e-PainSupport in an NIH-funded randomized controlled trial with 44 hospice patient and caregiver dyads. Utilizing a two-group, two-week, randomized controlled trial with dyads (N = 44) of Hospice patients (52% female, mean age 74.1 years) and their caregivers (75% female, mean age 55.2 years), dyads were randomly assigned to either the e-PainSupport intervention or usual care control condition. Outcome measures included caregiver knowledge and patient-reported pain intensity. Results: In the study, 60.87% of caregivers used the app's educational element at least once, with an average use of 5.43 times. Pain assessments were recorded by 91.30% of caregivers, averaging 3.74 assessments per caregiver. Additionally, 87.00% of caregivers reported pain management activities, averaging 46.05 entries. Patient pain intensity was tracked by 87.00% of caregivers, who completed the end-of-day summaries an average of 4.9 out of 14 days. Patients in the intervention condition were 2.50 times more likely to have a decrease in pain for worst pain than patients in the control condition over the two-week study period. Although we observed a positive effect of the app on caregivers' pain management knowledge, the improvement was limited, likely due to the brevity of the educational modules designed to minimize caregiver burden. To enhance caregiver knowledge without increasing their burden, we propose converting the written educational materials into videos. The enhanced intervention will be tested in a larger, full-scale RCT in the future. Conclusions: The use of the e-PainSupport app by caregivers is feasible and may contribute to improved caregiver knowledge and reduced hospice patient pain. Clinical trial information: NCT04869085 .