The e-PainSupport Digital Application for Assessing Pain and Pain Management in Home Hospice: A Randomized Controlled Trial.
Masako Mayahara, JoEllen Wilbur, Louis Fogg and 4 others
PMID 40495339WHAT IT FOUND
The caregiver app bundle, which combined education, tracking, and nurse alerts, did not lower patient pain more than usual hospice care over 14 days.
Caregiver medication adherence improved more than in usual care, but the main pain outcome was null.
Key findings
01The primary pain outcome did not improve significantly more with e-PainSupport than usual care from baseline to 14 days; the effect was small (d = 0.27).
02Caregiver adherence to analgesic regimens improved more in the e-PainSupport group than usual care (mean change 0.22 vs -0.24; P = .003; d = 0.97).
03In complete-case analysis, intervention patients were 2.50 times more likely to have a decrease in worst pain, 3.38 times more likely for average pain, and 2.50 times more likely for current pain than control patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study planned 92 dyads but randomized only 44 because of pandemic restrictions. Missing data were imputed, and 4 dyads were lost to follow-up; patient death was the main reason for partial or lost cases. Blinding was reported only for post-intervention data collectors. The app combined education, tracking, and nurse alerts, and the study did not include a comparison group receiving only the tracker. Only 14 of 23 intervention caregivers used the education element at least once. The adherence measure had a Cronbach's alpha of 0.39 in this study. Patients had to be cognitively intact, English-speaking, able to verbalize pain, and expected to survive 2 weeks. Follow-up was only 14 days, and the paper notes 25% mortality was expected in this population. The response-rate findings came from complete-case secondary analysis, not the primary outcome.
Declared interests
The article is labelled as NIH extramural supported. The provided text does not state author conflicts.
The easy way to misread this
Do not read the reported 2.50 times, 3.38 times, and 2.50 times greater likelihood of pain decrease as proof the app lowers pain. Those were complete-case secondary analyses, while the primary pain outcome was null and the intervention combined education, tracking, and nurse alerts.