Equipping medical students to manage cancer pain: a comparison of three educational methods.

A Cancer Pain Structured Clinical Instruction Module (SCIM), with skills stations incorporating actual cancer patients, has been developed to enhance cancer pain education among our medical students. The Cancer Pain SCIM has not been compared with more traditional cancer pain education, thus the purpose of this study was to assess the effectiveness and durability of three educational methods for teaching cancer pain management to medical students compared with a control group. Four consecutive rotations of 32 third-year medical students participated in one of four cancer pain educational strategies: 1) control group with no formal cancer pain education, 2) CD-ROM self-instruction module on cancer pain, 3) a 2-hour Cancer Pain SCIM plus the CD-ROM information, and 4) Cancer Pain SCIM, plus CD-ROM, plus a structured home-hospice patient visit. The effectiveness of the educational interventions was assessed at 4 months post-instruction using a 4-component Cancer Pain Objective Structured Clinical Examination (OSCE). The main findings of this educational study are that: 1) all three educational groups performed better on the Cancer Pain OSCE at 4 months than the control group (P<0.05); 2) medical students receiving structured education on cancer pain management significantly out-performed students at 4 months compared with control or traditional instructional formats; 3) students receiving the Cancer Pain SCIM plus home visit performed highest on the pain management, physical exam, and communication stations of the OSCE; and 4) the SCIM format of education shows durability as assessed at 4 months post-instruction. The Cancer Pain SCIM has a unique potential to substantially improve the quality of cancer pain education.

The carrot and the stick: benefits and barriers in getting a diagnosis.

The goals of this study were to identify the benefits and barriers perceived by family caregivers of persons who have been through a diagnostic assessment for dementia symptoms and to determine which caregivers experience more benefits and barriers associated with assessments. A survey was mailed to caregivers involved in the decision to seek a diagnostic assessment for a family member at a University of Kentucky memory disorders clinic. A total of 528 family caregivers (response rate 71.7%) returned a 4-page survey designed to elicit benefits, barriers, and demographic information. Respondents delayed the diagnostic assessment for an average of 22.4 months after noticing symptoms. Perceived benefits involved confirmation of a medical condition, access to treatment, and help preparing for the caregiving role. Barriers were both emotional and pragmatic in nature. Respondents who were younger, visited the rural assessment clinic, and had less education experienced more barriers. All groups reported receiving the same number of benefits from the assessment. By incorporating these benefits and barriers, interventions can be designed to increase the likelihood of early diagnostic assessments.

Use of alternative medications in patients with neurologic disorders.

OBJECTIVE: To determine alternative medication use in a neurology clinic population and to predict patients likely to use alternative medications. DESIGN: Survey of 216 adults presenting to a university-affiliated neurology clinic. METHODS: Subjects were queried regarding diagnosis, medications, satisfaction with medications, alternative medications, and demographics. Alternative medications were defined as herbal therapies, holistic therapies, minerals, or vitamins other than multiple vitamins. Frequencies were tabulated for categorical data; means and standard deviations were calculated for continuous data. Logistic regression was performed to predict use of alternative therapies. RESULTS: The most frequent conditions seen in all subjects were headache, epilepsy, and stroke. Mean ratings of patients' satisfaction with their conventional medications and health were 6.8 +/- 2.64 and 6.4 +/- 2.23 on a 10-point scale, respectively. Forty subjects were taking alternative therapies. Regression analysis suggests that patients with higher levels of education are more likely to use alternative therapies. CONCLUSIONS: Forty of 216 subjects (18.5%) seen in the neurology clinic took alternative therapies. Increased educational level was associated with use of alternative therapies.

Essential information and support needs of family caregivers.

The purpose of this study was to identify essential information and support needs of family caregivers for individuals with Alzheimer's disease or a related dementia, and to examine the relationship between caregiver characteristics and needs. Caregivers (n=128, response rate=49.4%) returned a survey detailing information needs, support needs, and personal information. The need for information concerning diagnosis/treatment and legal/financial issues was more important than general information about the disease. Specifically, information about health plan coverage was most important. Experienced caregivers also needed legal/financial information, as well as support. Female caregivers rated needs related to support as significantly more important than male caregivers. Practitioners should realize that caregivers may have different information and support needs and these needs may change throughout the caregiving experience.

Cancer pain education for medical students: the development of a short course on CD-ROM.

OBJECTIVE: The purpose of this study was to assess the educational value and acceptability of a short CD-ROM course on cancer pain management given to third-year medical students at the University of Kentucky. METHODS: Thirty-six medical students were given a short-course CD-ROM on cancer pain assessment and management. The Cancer Pain CD-ROM included textual instruction as well as video clips and a 15-item interactive self-assessment examination on cancer pain management. Students were asked to evaluate the computerized course with an 18-item survey using a Likert scale (1 = strongly disagree; 5 = strongly agree). RESULTS: Twenty-seven medical students completed the course, however, only 11 returned evaluations. In general, the medical students appreciated the CD-ROM material, with the exception of the video clips. Students agreed most strongly (mean +/- standard deviation [SD]) that the educational material on the CD-ROM was presented clearly (3.9 +/- 1.1), the CD-ROM format was easy to use (4.0 +/- 0.8), the CD-ROM course improved knowledge of opioid use for cancer pain (4.0 +/- 0.7), and the course improved understanding of opioid-related side effects (4.0 +/- 0.7). The self-assessment examination on cancer pain was rated easy to use and felt to be helpful (4.0 +/- 0.9) for students to identify cancer pain knowledge deficits. The authors estimate that 150 man-hours were needed to complete production of the CD-ROM without any specialized training in computer skills. CONCLUSIONS: A short-course computer format program was developed by the authors to teach the basics of cancer pain management to medical students. A minority of students evaluated the program and agreed the material was clearly presented, improved knowledge of opioid analgesia, and was easy to use.