Browsing by Author "Keefe, Francis J."

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    Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial
    (Elsevier, 2021) Kelleher, Sarah A.; Winger, Joseph G.; Fisher, Hannah M.; Miller, Shannon N.; Reed, Shelby D.; Thorn, Beverly E.; Spring, Bonnie; Samsa, Gregory P.; Majestic, Catherine M.; Shelby, Rebecca A.; Sutton, Linda M.; Keefe, Francis J.; Somers, Tamara J.; Duke University; University of Alabama Tuscaloosa; Northwestern University; Feinberg School of Medicine
    Background: Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interventions, face travel barriers to regional medical centers, and may have low literacy and limited resources. mHealth technologies have the potential to decrease barriers but must be carefully adapted for, and efficacy-tested with, medically underserved patients. We developed an mHealth behavioral pain coping skills training intervention (mPCST-Community). We now utilize a multisite randomized controlled trial to: 1) test the extent mPCST-Community reduces breast cancer patients' pain severity (primary outcome), pain interference, fatigue, physical disability, and psychological distress; 2) examine potential mediators of inter-vention effects; and 3) evaluate the intervention's cost and cost-effectiveness. Methods/design: Breast cancer patients (N = 180) will be randomized to mPCST-Community or an attention control. mPCST-Community's four-session protocol will be delivered via videoconferencing at an underserved community clinic by a remote pain therapist at a major medical center. Videoconference sessions will be sup-plemented with a mobile application. Participants will complete self-report measures at baseline, post-intervention, and 3-and 6-month follow-ups. Conclusions: mPCST-Community has the potential to reduce pain and disability, and decrease barriers for cancer patients in medically underserved areas. This is one of the first trials to test an mHealth behavioral cancer pain intervention developed specifically for medically underserved communities. If successful, it could lead to widespread implementation and decreased health disparities.
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    Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities
    (Routledge, 2019) Dorfman, Caroline S.; Kelleher, Sarah A.; Winger, Joseph G.; Shelby, Rebecca A.; Thorn, Beverly E.; Sutton, Linda M.; Keefe, Francis J.; Gandhi, Vicky; Manohar, Preethi; Somers, Tamara J.; Duke University; University of Alabama Tuscaloosa
    The purpose of this study was to refine and test a mobile-health behavioral cancer pain coping skills training protocol for women with breast cancer and pain from medically underserved areas. Three focus groups (Phase 1) were used to refine the initial protocol. A single-arm pilot trial (Phase 2) was conducted to assess feasibility, acceptability, and changes in outcomes. The intervention was delivered at a community-based clinic via videoconferencing technology. Participants were women (N = 19 for Phase 1 and N = 20 for Phase 2) with breast cancer and pain in medically underserved areas. Major themes from focus groups were used to refine the intervention. The refined intervention demonstrated feasibility and acceptability. Participants reported significant improvement in pain severity, pain interference, and self-efficacy for pain management. Our intervention is feasible, acceptable, and likely to lead to improvement in pain-related outcomes for breast cancer patients in medically underserved areas.
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    Global Versus Momentary Osteoarthritis Pain and Emotional Distress: Emotional Intelligence as Moderator
    (Oxford University Press, 2018) Parmelee, Patricia A.; Scicolone, Monica A.; Cox, Brian S.; DeCaro, Jason A.; Keefe, Francis J.; Smith, Dylan M.; University of Alabama Tuscaloosa; Duke University; State University of New York (SUNY) Stony Brook
    Background Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association. Purpose Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels. Methods In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health. Results Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging. Conclusions Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.
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    Momentary Associations of Osteoarthritis Pain and Affect: Depression as Moderator
    (Oxford University Press, 2022) Parmelee, Patricia A.; Behrens, Emily A.; Costlow Hill, Kyrsten; Cox, Brian S.; DeCaro, Jason A.; Keefe, Francis J.; Smith, Dylan M.; University of Alabama Tuscaloosa; Duke University; State University of New York (SUNY) Stony Brook
    Objectives This research examined main and moderating effects of global depressive symptoms upon in-the-moment associations of pain and affect among individuals with knee osteoarthritis (OA). Effects of depression on short-term change in pain and affect were also examined. Method Older adults with physician-confirmed OA (N = 325) completed a baseline interview tapping global depressive symptoms, followed by an experience sampling protocol that captured momentary pain and affect 4 times daily for 7 days. Multilevel models controlling demographics and health conditions examined main and moderating effects of depression on momentary associations of pain with positive affect (PA) and negative affect (NA). Similar methods addressed short-term change in pain and affect. Auxiliary analyses explored broad associations of depressive symptoms with person-level averages and variability in pain and affect. Results Global depression predicted current pain, PA, and NA, as well as change in pain and affect over a 3- to 8-h period. Furthermore, both in the moment and over short periods, the association of pain and NA was stronger among persons higher in depressive symptoms. No moderating effect for the PA-pain association was found. Depressive symptoms were also associated with variability in pain and affect, particularly NA. Discussion Results confirm previous work on the relation of chronic pain with both global depressive symptoms and short-term affect. This research further demonstrates a unique moderating role of depression on the association of momentary pain with NA and suggests that the causal path may be stronger from pain to affect than vice versa.
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    The Role of Cognitive Content and Cognitive Processes in Chronic Pain: An Important Distinction?
    (Lippincott Williams & Wilkins, 2018) Jensen, Mark P.; Thorn, Beverly E.; Carmody, James; Keefe, Francis J.; Burns, John W.; University of Washington; University of Washington Seattle; University of Alabama Tuscaloosa; University of Massachusetts Worcester; Duke University; Rush University
    Objectives:Pain-related cognitive content (what people think about pain) and cognitive processes (how people think about pain; what they do with their pain-related thoughts) and their interaction are hypothesized to play distinct roles in patient function. However, questions have been raised regarding whether it is possible or practical to assess cognitive content and cognitive process as distinct domains. The aim of this study was to determine the extent to which measures that seem to assess mostly pain-related cognitive content, cognitive processes, and content and process, are relatively independent from each other and contribute unique variance to the prediction of patient function.Materials and Methods:Individuals with chronic low back pain (N=165) participating in an ongoing RCT were administered measures of cognitions, pain, and function (depressive symptoms and pain interference) pretreatment.Results:Analyses provided support for the hypothesis that cognitive content and cognitive process, while related, can be assessed as distinct components. However, the measure assessing a cognitive processmindfulnessevidenced relatively weak associations with function, especially compared with the stronger and more consistent findings for the measures of content (catastrophizing and self-efficacy).Discussion:The results provide preliminary evidence for the possibility that mindfulness could have both benefits and costs. Research to evaluate this possibility is warranted.