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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)
Information on opioid dosage, conversion and use in patients who are older and/or have renal failure
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
Local data on prevalence of cancer pain and performance on quality indicators
Data on hospitalisations and other healthcare costs resulting from cancer pain
Incentivisation - Creating expectation of reward/Coercion Creating expectation of punishment or cost Goal setting, monitoring of pain
Quality improvement targets on pain assessment, management and outcomes
Training - Imparting skills Skills development in rating pain severity and self-managing pain
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
League table (SPACED LEARNING,)
Modelling change
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
Patient-held record supports information transfer and care coordination between providers