For Physicians

Doctor Kalauokalani's Publications

The following list of publications is provided by ResearchGate:

  • Article: Cancer Health Empowerment for Living without Pain (Ca-HELP): effects of a tailored education and coaching intervention on pain and impairment.
    ABSTRACT: We aimed to determine the effectiveness of a lay-administered tailored education and coaching (TEC) intervention (aimed at reducing pain misconceptions and enhancing self-efficacy for communicating with physicians) on cancer pain severity, pain-related impairment, and quality of life. Cancer patients with baseline "worst pain" of ≥4 on a 0-10 scale or at least moderate functional impairment due to pain were randomly assigned to TEC or enhanced usual care (EUC) during a telephone interview conducted in advance of a planned oncology office visit (265 patients randomized to TEC or EUC; 258 completed at least one follow-up). Patients completed questionnaires before and after the visit and were interviewed by telephone at 2, 6, and 12 weeks. Mixed effects regressions were used to evaluate the intervention adjusting for patient, practice, and site characteristics. Compared to EUC, TEC was associated with increased pain communication self-efficacy after the intervention (P<.001); both groups showed significant (P<.0001), similar, reductions in pain misconceptions. At 2 weeks, assignment to TEC was associated with improvement in pain-related impairment (-0.25 points on a 5-point scale, 95% confidence interval -0.43 to -0.06, P=.01) but not in pain severity (-0.21 points on an 11-point scale, -0.60 to 0.17, P=.27). The improvement in pain-related impairment was not sustained at 6 and 12 weeks. There were no significant intervention by subgroup interactions (P>.10). We conclude that TEC, compared with EUC, resulted in improved pain communication self-efficacy and temporary improvement in pain-related impairment, but no improvement in pain severity.
    Pain 03/2011; 152(7):1572-82. · 5.78 Impact Factor
  • Article: Improving physician-patient communication about cancer pain with a tailored education-coaching intervention.
    ABSTRACT: This study examined the effect of a theoretically grounded, tailored education-coaching intervention to help patients more effectively discuss their pain-related questions, concerns, and preferences with physicians. Grounded in social-cognitive and communication theory, a tailored education-coaching (TEC) intervention was developed to help patients learn pain management and communication skills. In a RCT, 148 cancer patients agreed to have their consultations audio-recorded and were assigned to the intervention or a control group. The recordings were used to code for patients' questions, acts of assertiveness, and expressed concerns and to rate the quality of physicians' communication. Patients in the TEC group discussed their pain concerns more than did patients in the control group. More active patients also had more baseline pain and interacted with physicians using participatory decision-making. Ratings of physicians' information about pain were higher when patients talked more about their pain concerns. The study demonstrates the efficacy of a theoretically grounded, coaching intervention to help cancer patients talk about pain control. Coaching interventions can be effective resources for helping cancer patients communicate about their pain concerns if they are theoretically grounded, can be integrated within clinical routines, and lead to improve health outcomes.
    Patient Education and Counseling 12/2009; 80(1):42-7. · 2.31 Impact Factor
  • Article: Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain
    BMC Cancer 09/2009; · 3.01 Impact Factor
  • Article: Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain
    ABSTRACT: Abstract Background Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes. Methods/Design The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California. A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray). Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding. Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks. Discussion Building on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care. If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. Trial Registration [Clinical Trials Identifier: NCT00283166]
    BMC Cancer. 01/2009;
  • Article: Provider judgments of patients in pain: seeking symptom certainty.
    ABSTRACT: Uncertainty often surrounds judgments of pain, especially when pain is chronic. In order to simplify their decisions, providers adduce information from a variety of sources. Unfortunately, an extensive literature suggests that the information that is brought to bear actually can bias pain judgments, resulting in judgments that consistently differ from patient reports, with a potential negative impact on treatment. This review examines the pain assessment literature from a social cognition perspective that emphasizes interpersonal and situational factors that can influence judgments. Consistent with that model, it organizes research findings into three broad domains that have been shown to systematically influence assessments of pain, involving patient, provider, and situational factors. A causal model for pain judgment is proposed, and its implications for clinical research and practice are explored. In order to minimize the uncertainty that can characterize symptoms such as chronic pain, practitioners bring information to bear on pain assessment that can lead to misjudgments. While intuitively appealing, much of the information that is considered often has little association with pain severity and/or adjustment. A more rational decision-making process can reduce the judgment errors common to pain assessment and treatment.
    Pain Medicine 12/2008; 10(1):11-34. · 2.35 Impact Factor
  • Article: Pain management for older adults: a self-help guide.
    Pain Medicine 12/2008; 9(8):1227. · 2.35 Impact Factor
  • Article: Ethical aspects of placebo groups in pain trials: lessons from psychiatry.
    ABSTRACT: Placebo control use in clinical research is contentious in areas where effective treatments already exist. Determination of appropriate standards for placebo use is especially difficult in areas such as pain treatment and psychiatry, in which substantial placebo responses can occur. Debates are characterized by three common themes: (a) whether the state of existing treatments forbids placebo use, (b) whether the nature of the condition being treated and the level of additional risk permit placebo control use, and (c) whether methodological concerns are sufficient to justify placebo use. A review of these themes in the psychiatric research literature suggests possible strategies for analysis of this issue in the area of pain research.
    Neurology 01/2006; 65(12 Suppl 4):S59-65. · 8.31 Impact Factor
  • Article: Anticipating and treating opioidassociated adverse effects
    ABSTRACT: Opioids are frequently avoided as viable tools in the management of pain due to perceived dangerous or untoward adverse drug events. Whilst they are relatively safe options for the treatment of pain, side effects and toxicities do exist and should be anticipated by the provider. The central nervous, gastrointestinal, genito-urinary, integumentary, metabolic/endocrine, cardiovascular, pulmonary, hepatic/renal, ocular and immune systems all manifest changes associated with opioid therapy. These adverse events, ranging from nuisance to therapy-limiting, are manageable when addressed quickly and appropriately. Opioids are safe and efficacious analgesics when these effects are considered.
    03/2005; 2(3):305-319.
  • Article: The unequal burden of pain: confronting racial and ethnic disparities in pain.
    ABSTRACT: Pain has significant socioeconomic, health, and quality-of-life implications. Racial- and ethnic-based differences in the pain care experience have been described. Racial and ethnic minorities tend to be undertreated for pain when compared with non-Hispanic Whites. To provide health care providers, researchers, health care policy analysts, government officials, patients, and the general public with pertinent evidence regarding differences in pain perception, assessment, and treatment for racial and ethnic minorities. Evidence is provided for racial- and ethnic-based differences in pain care across different types of pain (i.e., experimental pain, acute postoperative pain, cancer pain, chronic non-malignant pain) and settings (i.e., emergency department). Pertinent literature on patient, health care provider, and health care system factors that contribute to racial and ethnic disparities in pain treatment are provided. A selective literature review was performed by experts in pain. The experts developed abstracts with relevant citations on racial and ethnic disparities within their specific areas of expertise. Scientific evidence was given precedence over anecdotal experience. The abstracts were compiled for this manuscript. The draft manuscript was made available to the experts for comment and review prior to submission for publication. Consistent with the Institute of Medicine's report on health care disparities, racial and ethnic disparities in pain perception, assessment, and treatment were found in all settings (i.e., postoperative, emergency room) and across all types of pain (i.e., acute, cancer, chronic nonmalignant, and experimental). The literature suggests that the sources of pain disparities among racial and ethnic minorities are complex, involving patient (e.g., patient/health care provider communication, attitudes), health care provider (e.g., decision making), and health care system (e.g., access to pain medication) factors. There is a need for improved training for health care providers and educational interventions for patients. A comprehensive pain research agenda is necessary to address pain disparities among racial and ethnic minorities.
    Pain Medicine 10/2003; 4(3):277-94. · 2.35 Impact Factor
  • Article: Anticipating and treating opioid-associated adverse effects.
    ABSTRACT: Opioids are frequently avoided as viable tools in the management of pain due to perceived dangerous or untoward adverse drug events. Whilst they are relatively safe options for the treatment of pain, side effects and toxicities do exist and should be anticipated by the provider. The central nervous, gastrointestinal, genito-urinary, integumentary, metabolic/endocrine, cardiovascular, pulmonary, hepatic/renal, ocular and immune systems all manifest changes associated with opioid therapy. These adverse events, ranging from nuisance to therapy-limiting, are manageable when addressed quickly and appropriately. Opioids are safe and efficacious analgesics when these effects are considered.
    Expert Opinion on Drug Safety 06/2003; 2(3):305-19. · 3.02 Impact Factor
  • Article: Epidural anesthesia and analgesia: is there really no benefit?
    Anesthesiology 11/2002; 97(4):1027; author reply 1029-31. · 5.36 Impact Factor
  • Article: Cognitive-behavioral therapy and psychosocial factors in low back pain: directions for the future.
    ABSTRACT: An amalgamated review of the current state of knowledge about psychosocial factors in low back pain (LBP), as presented at the plenary session at the Fourth International Forum on LBP Research in Primary Care (March 16-18, 2000, Israel). To outline evidence-based theories that have lead to the identification of yellow flags (psychosocial risk factors for developing long-term disability) for nonspecific LBP. To discuss the role of clinicians in primary care in detecting and addressing these psychosocial factors and to outline future directions for research to clarify this role. It is widely accepted that psychological and social factors play an important role in LBP; however, it is currently unclear which specific factors merit intervention to reduce the burden of disease. The review is an integration based on the plenary session presented at the Fourth International Forum on LBP Research in Primary Care. The presentations included original research studies, a systematic review, and theoretical descriptions of models of risk and treatment. There is good evidence to support the role of psychological risk factors at early stages of LBP in the development of long-term disability. There are evidence-based theories and models that provide directions for future interventions. In the treatment of psychological factors, the role of clinicians in primary care remains unclear. Further evidence is needed to identify specific psychological risk factors, primary care tools for their identification need developing, and interventions at different stages of LBP by different professionals need to be tested.
    Spine 04/2002; 27(5):E133-8. · 2.08 Impact Factor
  • Article: Pain treatment in the perioperative period.
    Current Problems in Surgery 12/2001; 38(11):835-920. · 2.33 Impact Factor
  • Article: Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects.
    ABSTRACT: A subanalysis of data derived from a randomized clinical trial was performed. To evaluate the association of a patient's expectation for benefit from a specific treatment with improved functional outcome. Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain. The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered. In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale. After adjustment for baseline characteristics, improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations (P = 0.01). Furthermore, patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa (P = 0.03). The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself. In contrast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.
    Spine 08/2001; 26(13):1418-24. · 2.08 Impact Factor
  • Article: Acupuncture for chronic low back pain: diagnosis and treatment patterns among acupuncturists evaluating the same patient.
    ABSTRACT: There is increasing need to examine the effectiveness of acupuncture and other alternative therapies for common conditions. However, little attention has focused on the variability in acupuncturists' assessment, diagnosis, and treatment patterns. Seven office-based acupuncturists practicing Traditional Chinese Medicine evaluated the same patient with chronic low back pain and provided data regarding principal assessment techniques, diagnoses, and therapeutic recommendations. A high diagnostic agreement existed among 5 of 7 acupuncturists. However, recommended treatments included varying numbers and locations of acupuncture points. Recommendations varied between 5 and 14 points requiring 7 to 26 needles, since many points were intended for bilateral application. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. Most recommended various forms of adjuvant heat. Seven acupuncturists agreed considerably in the diagnoses for the same patient with chronic low back pain, but treatment recommendations varied substantially. Clinicians and researchers must recognize treatment recommendation variations and the challenges they present for study design and interpretation.
    Southern Medical Journal 06/2001; 94(5):486-92. · 0.83 Impact Factor
  • Article: The evolving management of varicose veins. Straub Clinic experience.
    Postgraduate Medicine 10/1986; 80(4):51-3, 56-9. · 1.78 Impact Factor
  • Article: A comparison of physician and nonphysician acupuncture treatment for chronic low back pain.
    ABSTRACT: Although up to a third of the 10,000 acupuncturists in the United States are medical doctors, little is known about the acupuncture techniques they use or how their practices compare with those of nonphysician licensed acupuncturists. This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupuncture. This study describes how a random sample of physician acupuncturists in the United States diagnose and treat chronic low back pain and contrasts their practices with those of nonphysician licensed acupuncturists. A total of 464 questionnaires were mailed to physician acupuncturists randomly sampled from 3 sources: web-based Yellow Pages, American Academy of Medical Acupuncturists (AAMA) membership, and Pain Clinics associated with American College of Graduate Medical Education-approved fellowship programs. Responses (n=137, 30%) were analyzed using descriptive statistics. The results of this survey were compared with data published from a similar survey of nonphysician licensed acupuncturists in Washington State. Physicians who perform acupuncture use a mixture of styles and emphasize neuroanatomic approaches to needle placement. Most physicians received training in French Energetic acupuncture. In contrast, most nonphysician licensed acupuncturists use a traditional Chinese medicine approach to needle placement. Despite this apparent difference in their predominant styles of acupuncture, there was a high correlation between physician and nonphysician licensed acupuncturist acupoint selection to treat low back pain. In addition to acupuncture needling, physicians use other medical treatments, whereas nonphysician licensed acupuncturists' employ a variety of traditional Chinese medicine adjuncts to needling. This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain.
    Clinical Journal of Pain 21(5):406-11. · 2.81 Impact Factor
  • Article: Bee stings--a remedy for postherpetic neuralgia? A case report.
    ABSTRACT: This case report describes the effects of bee stings on painful postherpetic neuralgia in a 51-year-old man. The patient was stung by 3 bees in the distribution in which he had been experiencing postherpetic neuralgia. One day after the bee stings, the patient's painful postherpetic neuralgia was completely relieved, and the relief lasted for 1 and a half months. Subsequently, the patient's pain returned, but at significantly less intensity and frequency than what he had experienced prior to the bee stings. Bee venom and bee sting therapy have been shown to have both antinociceptive and anti-inflammatory properties, which may explain why the bee stings relieved the patient's postherpetic neuralgia. Bee sting or bee venom therapy should be further investigated as a potential treatment modality for postherpetic neuralgia.
    Regional Anesthesia and Pain Medicine 32(6):533-5. · 4.08 Impact Factor
  • Article: Can patient coaching reduce racial/ethnic disparities in cancer pain control? Secondary analysis of a randomized controlled trial.
    ABSTRACT: Minority patients with cancer experience worse control of their pain than do their white counterparts. This disparity may, in part, reflect more miscommunication between minority patients and their physicians. Therefore, we examined whether patient coaching could reduce disparities in pain control in a secondary analysis of a randomized controlled trial. Sixty-seven English-speaking adult cancer outpatients, including 15 minorities, with moderate pain over the prior 2 weeks were randomly assigned to the experimental (N = 34) or control group (N = 33). Experimental patients received a 20-minute individualized education and coaching session to increase knowledge of pain self-management, to redress personal misconceptions about pain treatment, and to rehearse an individually scripted patient-physician dialog about pain control. The control group received standardized information on controlling pain. Data on average pain (0-10 scale) were collected at enrollment and 2-week follow-up. At enrollment, minority patients had significantly more pain than their white counterparts (6.0 vs 5.0, P = 0.05). At follow-up, minorities in the control group continued to have more pain (6.4 vs 4.7, P = 0.01), whereas in the experimental group, disparities were eliminated (4.0 vs 4.3, P = 0.71). The effect of the intervention on reducing disparities was significant (P = 0.04). Patient coaching offers promise as a means of reducing racial/ethnic disparities in pain control. Larger studies are needed to validate these findings and to explore possible mechanisms.
    Pain Medicine 8(1):17-24. · 2.35 Impact Factor