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Browsing by Author "Theobald, Dale"
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Item Cancer-Related Pain and Disability: A Longitudinal Study(2011-12) Wang, Hsiao-Lan; Kroenke, Kurt; Wu, Jingwei; Tu, Wanzhu; Theobald, Dale; Rawl, Susan M.Context Although the cross-sectional association between cancer-related pain and disability is well established, their longitudinal relationship has been less studied. Objectives Data from the Indiana Cancer Pain and Depression (INCPAD) trial were analyzed to determine whether baseline cancer-related pain and changes in pain over time predict disability over 12 months. Methods A total of 274 cancer survivors with cancer-related pain were accrued in the INCPAD trial. Data were collected at baseline, one, three, six, and 12 months by interviewers blinded to treatment arm. Disability outcomes included a continuous measure (Sheehan Disability Scale [SDS] score) and a categorical measure (≥14 days in the past four weeks with a ≥50% reduction in usual activities). Predictor variables, operationalized by the Brief Pain Inventory, included baseline pain severity and changes in pain severity scores between each time point. Multivariable analyses were conducted adjusting for treatment group, baseline disability, and selected covariates including depression. Results Baseline pain severity did not predict disability outcomes at 12 months. However, improvement in pain severity predicted less disability over 12 months both in terms of SDS scores (b = −0.17, t = −5.33, P < 0.001) and ≥14 disability days in the past month (odds ratio = 0.85; 95% confidence interval, 0.79–0.93; P < 0.001). Conclusion Disability over 12 months in patients with cancer-related pain is predicted by changes in pain severity over time. Results suggest that effective pain management may reduce subsequent disability among cancer survivors.Item Comparative Responsiveness of Pain Measures in Cancer Patients(Elsevier, 2012-08) Kroenke, Kurt; Theobald, Dale; Wu, Jingwei; Tu, Wanzhu; Krebs, Erin E.; Department of Medicine, IU School of MedicineBrief measures to assess and monitor pain in cancer patients are available, but few head-to-head psychometric comparisons of different measures have been reported. Baseline and 3-month data were analyzed from 274 patients enrolled in the Indiana Cancer Pain and Depression (INCPAD) trial. Participants completed the Brief Pain Inventory (BPI), the PEG (a 3-item abbreviated version of the BPI), the short form (SF)-36 pain scale, and a pain global rating of change measure. The global rating was used as the criterion for standardized response mean and receiver operating characteristic curve analyses. To assess responsiveness to the trial intervention, we evaluated standardized effect size statistics stratified by trial arm. All measures were responsive to global improvement, discriminated between participants with and without improvement, and detected a significant intervention treatment effect. Short and longer measures were similarly responsive. Also, composite measures that combined pain severity and interference into a single score (BPI total, PEG, SF-36 pain) performed comparably to separate measures of each domain (BPI severity and BPI interference).Item The P4 Screener: Evaluation of a Brief Measure for Assessing Potential Suicide Risk in 2 Randomized Effectiveness Trials of Primary Care and Oncology Patients(2010-05) Dube, Priyanka; Kroenke, Kurt; Blair, Matthew J; Theobald, Dale; Williams, Linda S.Background: Depression is the most common mental disorder, and suicide is its most serious consequence. The primary objective of this study was to evaluate preliminary evidence for the P4 screener as a brief measure to assess potential suicide risk. Method: The P4 screener was prospectively evaluated in 2 randomized effectiveness trials of primary care (January 2005–June 2008; N = 250) and oncology patients (March 2006–August 2009; N = 309). Potential suicide ideation was assessed at 5 time points in both trials: baseline and 1, 3, 6, and 12 months. The P4 screener asks about the “4 P’s”: past suicide attempts, suicide plan, probability of completing suicide, and preventive factors. Patients were classified as minimal, lower, and higher risk based upon responses to these 4 items. Results: A suicide assessment was triggered 1 or more times by 17.6% (44 of 250) of Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) participants and 16.5% (51 of 309) of Indiana Cancer Pain and Depression (INCPAD) participants at some point in the trial. Of the patients who triggered a suicide assessment, the majority (29 of 44 in SCAMP and 27 of 51 in INCPAD) were classified as minimal risk by the algorithm. Only 1 (0.4%) of the SCAMP participants and 5 (1.6%) of the INCPAD participants were classified as higher risk. Among the latter, the most common factors preventing patients from attempting suicide were the “4 F’s”: faith, family, future hope, and fear of failing in their attempt. Conclusions: Preliminary findings suggest that the P4 screener may be useful in assessing potential suicide risk in the clinical care of depressed patients as well as in clinical research.Item Predictors of Cancer-related Pain Improvement Over Time(2012-07) Wang, Hsiao-Lan; Kroenke, Kurt; Wu, Jingwei; Tu, Wanzhu; Theobald, Dale; Rawl, Susan M.Objective To determine the predictors of pain improvement among patients being treated for cancer-related pain over 12 months. Methods A secondary analysis of the telephone care Indiana Cancer Pain and Depression trial was performed. Patients (n = 274) were interviewed at baseline and after 1, 3, 6, and 12 months. Pain improvement outcomes included both a continuous measure (Brief Pain Inventory score) and a categorical measure (pain improved versus pain not improved). Predictor variables included change in depression, age, sex, race, marital status, socioeconomic disadvantage, medical comorbidity, type of cancer, and phase of cancer. Multivariable repeated measures were conducted, adjusting for intervention group assignment, baseline pain severity, and time in months since baseline assessment. Results Factors significantly predicting both continuous and categorical pain improvement included participating in the intervention group (β = −0.92, p < .001, odds ratio [OR] = 2.53, 95% confidence interval [CI] = 1.65–3.89), greater improvement in depression (β = −0.31, p = .003, OR = 1.84, 95% CI = 1.35–2.51), higher socioeconomic status (Socioeconomic Disadvantage index; β = 0.25, p = .034; OR = 0.73, 95% CI = 0.56–0.94), and fewer comorbid conditions (β = 0.20, p = .002; OR = 0.84, 95% CI = 0.73–0.96). Patients with more severe pain at baseline or with recurrent or progressive cancer were less likely to experience continuous or categorical pain improvement, respectively. Conclusions Effective management of depression and comorbid conditions along with improvement of social services could be critical components of a comprehensive pain management. Patients with more severe pain or with recurrent or progressive cancers may require closer monitoring and adequate treatment of pain.