Assessing and Treating Pain in Hospices: Current State of Evidence-Based Practices

Abstract

The aim of this article is to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index (CPPI), a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of the those key evidence-based practices (EBPs) that were applicable to their situation. When examining individual practices, the majority of patients had their pain assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps including: additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the Pain Treatment Plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by pain medication increases (15.8%); monitoring of analgesic-induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both non-pharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices.

The assessment and management of pain in an orthopaedic out-patient setting: A case study

“…They then went home. A re-assessment of pain is usually advocated but it couldn't take place for another week (Herr et al 2010;Mason et al 2011).…”

Impact of admission to hospice on pain intensity and type of pain therapies administered

“…Cancer pain management in a hospice setting has been the object of several articles, all of which conclude that consistent assessment, re-assessment, and treatment should be carried out according to evidence-based practice. However, in the study by Herr et al, this type of systematic management was performed in only 32 % of patients, the authors underlining that this percentage could be much improved in clinical practice [15]. Adherence to prescribed medication over time has been identified as a key element for treatment efficacy [18] and has also been reported as useful for maintaining good pain control after discharge from a hospice [19].…”

“…Although several studies have been published on the impact of hospice and end-of-life care on clinical outcomes [15][16][17], the effect of admission to hospice on pain control has not produced uniformly positive results. Our retrospective chart-review study aimed to assess the relationship between inpatient palliative care and pain intensity in a population of cognitively competent cancer patients admitted to a hospice.…”

Nursing’s Role in Cancer Pain Management

“…In the hospice arena, Herr et al [2] reported on provider evidence-based assessment and treatment practices for older adults with cancer in 16 community-based hospice settings. The positive aspects of the assessment included that most of the patients had their pain assessed at admission using a valid pain scale and had primary components of a comprehensive pain assessment completed at admission.…”