Identifying Opportunities to Improve Pain Among Patients With Serious Illness

Abstract

Context. Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. Objective. Identify characteristics associated with pain and pain improvement among inpatients referred to PC. Methods. Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. Results. Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR ¼ 2.9, P < 0.0001) and dyspnea (OR ¼ 1.4, P ¼ 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P ¼ 0.003). Conclusion. Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement.

Delivering Pediatric Palliative Care: From Denial, Palliphobia, Pallilalia to Palliactive

“…Brock et al describe in this special edition describe emerging methods of symptom and health-related quality-of-life assessment through patient-reported outcomes tools [ 31 ]. Data has shown, that distressing pain is very common among inpatients referred to palliative care and three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement [ 32 ]. The involvement of PPC team with adolescent and young adult oncology patients is associated with the receipt of less intensive treatments during the last month of life, such as being on a ventilator, invasive procedures, and fewer deaths in the intensive care unit [ 33 ].…”

Outcomes of Palliative Care Consultations for Hospitalized Patients With Liver Disease

“…We defined improvement in symptom severity as an improvement by at least one level of severity within 72 hours in patients who reported moderate or severe symptoms at the initial PC assessment. 25,26 For all analyses, an alpha of <0.05 was used to determine statistical significance. There was no adjustment or imputation for missing data; analyses were performed only for patients for whom data were available for each specific data element.…”

Pain Management: Time to Minimize Variations in Practice

“…This variation in performance has been highlighted in a recent study across 38 programs in the United States. 4 Within health care systems, we observe variations in the approach to management and time to control symptoms. This may vary between programs in the same hospital (eg, anesthesia pain versus palliative medicine versus surgical services) or in different hospitals within the same system.…”

“…How can the most important factor that dictates the delivery and timeliness of pain management be the culture of Pain Management: Time to Minimize Variations in Practice Parag Bharadwaj 1,2 , Brynn E Sheehan 3,4 , Sunita Dodani 5,6 and Charles F von Gunten 7…”

“…This variation in performance has been highlighted in a recent study across 38 programs in the United States. 4…”