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

Abstract

Mean ± SD pain NRS values of the entire group were 2.58 ± 2.61 on day 1 and 1.40 ± 1.72 on day 7 (P = 0.002). Restricting the analysis to patients with moderate to severe pain at the time of hospice admission, results were even more significant. In fact, mean ± SD pain NRS was 5.51 ± 1.24 for patients with pain ≥4 at admission and 1.76 ± 1.91 for the same patients after 7 days (P < 0.001). A significant increase in the number of patients receiving morphine was observed from day 1 to day 7 (24 to 41, respectively, P = 0.001) and in those receiving drugs via parenteral routes (subcutaneous or intravenous) from 10 to 27 (P = 0.002) CONCLUSIONS: Admission to a hospice and the hospice environment led to a significant reduction in reported pain intensity for the patients included in this study, mainly those with moderate to severe pain at the time of admission. This decrease in pain was accompanied by a significant increase in the use of morphine, especially via parenteral routes, but not by a higher mean equivalent daily dose of oral morphine per patient.

Pattern and characteristics of patients admitted to a hospice connected with an acute palliative care unit in a comprehensive cancer center

“…After admission there was a clear improvement of physical and psychological symptoms, as it often occurs in acute or home care settings [ 22 , 23 ], probably as a result of a comprehensive assessment and team experience in symptom control. In a retrospective study, admission to hospice led to a significant reduction of pain intensity, particularly in patients with moderate to severe pain [ 24 ]. It is likely that hospice policies are largely different among countries and even in the same country.…”

“…In a retrospective study, admission to a hospice led to a significant reduction in reported pain intensity for the patients. This decrease in pain was accompanied by a significant increase in the use of morphine, especially via parenteral routes, but not by a higher mean equivalent daily dose of oral morphine per patient [ 24 ]. Thus, hospice care provides an appropriate drug selection for symptom control in comparison with hospital non-specialized care.…”

Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate

“…Progress in symptom control, hospice, and palliative care belies this depiction of care at the end of life. [59][60][61][62][63][64][65][66][67] Moreover, progress in medical ethics has made it routine for patients to refuse lifesustaining therapies such as ventilators, dialysis, feeding tubes, and cardiopulmonary resuscitation that they judge to be more burdensome than beneficial, and then to be supported in dying. Acceptance of the principle of double effect makes it possible for patients to consent to be treated with sufficient doses of medication to control their symptoms even at the risk of unconsciousness or hastened death.…”