The e-PainSupport Digital Application for Assessing Pain and Pain Management in Home Hospice: A Randomized Controlled Trial

Background: Poor patient pain management in home hospice is associated with low family caregiver adherence to analgesic regimens. Health care technology can improve caregiver access to education and communication to hospice nurses. Objective: The study purpose was to (1) compare the effects of the e-PainSupport intervention for family caregivers on change in patient pain intensity from baseline to 14 days to the effects of a usual care control condition and (2) examine mediating effects of pain management knowledge, self-efficacy, and adherence to analgesic regimens on change in pain intensity, controlling for study condition and patient gender. Methods: Utilizing a 2-group, 2-week randomized controlled trial with dyads (N = 44) of 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. The e-PainSupport intervention included caregiver pain education, a pain assessment and management tracker, and communication to nurses. Participants were recruited from 4 hospice agencies in a large metropolitan area. Outcome measures included caregiver knowledge, self-efficacy, medication adherence, and patient-reported pain intensity. Results: The e-PainSupport intervention produced a small positive effect on reducing pain intensity (d = 0.27) and statistically significant increase in adherence (P = .003), compared with usual care. Hierarchical regression models showed a significant mediating effect of increased caregiver knowledge on reduced pain intensity (P < .01), regardless of condition. Conclusions: Caregiver use of the e-PainSupport app is feasible and may contribute to decreasing hospice patient pain. Clinical trial registration: The study was registered at ClinicalTrials.gov on May 3, 2021, NCT04869085. The first participant was enrolled on April 21, 2021.