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Table 1 Behaviour change ‘functions’ (Michie et al., 2011 [24]) and related strategies employed to overcome barriers to cancer pain assessment and management in the Stop Cancer PAIN Trial (adapted from [68])

From: Protocol for a phase III pragmatic stepped wedge cluster randomised controlled trial comparing the effectiveness and cost-effectiveness of screening and guidelines with, versus without, implementation strategies for improving pain in adults with cancer attending outpatient oncology and palliative care services: the Stop Cancer PAIN trial

Behaviour change function Strategies for overcoming barriers to cancer pain assessment and management
Patient level Clinician level Service/system levels
Education - Increasing knowledge or understanding Information on types of pain, medications and side-effects (including low risk of opioid addiction)
(OVERCOMING CANCER PAIN BOOKLET)
Information on opioid dosage, conversion and use in patients who are older and/or have renal failure
(GUIDELINES, SPACED LEARNING)
Data on prevalence of cancer pain enabling comparison between services (AUDIT)
Persuasion - Using communication to induce positive or negative feelings or stimulate action Goal setting, reflection on exacerbating/alleviating factors, management strategies, when/from whom to seek help aimed at reframing pain and promoting sense of control (SELF-MANAGEMENT RESOURCE) Patient advocacy for person-centred care
(SELF-MANAGEMENT RESOURCE)
Local data on prevalence of cancer pain and performance on quality indicators
(SCREEING, AUDIT)
Data on hospitalisations and other healthcare costs resulting from cancer pain
(ECONOMIC EVALUATION)
Incentivisation - Creating expectation of reward/Coercion Creating expectation of punishment or cost Goal setting, monitoring of pain
(SELF-MANAGEMENT RESOURCE)
Quality improvement targets on pain assessment, management and outcomes
(AUDIT)
Training - Imparting skills Skills development in rating pain severity and self-managing pain
(SELF-MANAGEMENT RESOURCE)
Skill development in assessment, management and providing patient education (SPACED LEARNING, SELF-MANAGEMENT RESOURCE) Development of service capacity to routinely screen for pain (SCREENING)
Environmental restructuring - Changing the physical or social context Encouraging reporting of pain (SCREENING, SELF-MANAGEMENT RESOURCE) Increased focus on cancer pain care (SCREENING, GUIDELINES, PATHWAY, AUDIT, SPACED LEARNING, SELF-MANAGEMENT RESOURCE)
Modelling - Providing an example for people to aspire to or imitate Personal stories of well managed pain
(OVERCOMING CANCER PAIN DVD)
League table (SPACED LEARNING,)
Modelling change
(CLINICAL CHANGE CHAMPIONS)
Community of practice
Enablement - Increasing means/reducing barriers to increase capability or opportunity Tools for promoting pain reporting, enhancing doctor/patient communication, and increasing priority/time accorded pain
(SCREENING, SELF-MANAGEMENT RESOURCES)
Patient-held record supports information transfer and care coordination between providers
(SELF-MANAGEMENT RESOURCES)
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