Pain and Its Treatment in Outpatients with Metastatic Cancer

Cleeland, Charles S.; Gonin, René; Hatfield, Alan K.; Edmonson, John H.; Blum, Ronald H.; Stewart, James A.; Pandya, Kishan J.

doi:10.1056/nejm199403033300902

Cited by 1,790 publications

(710 citation statements)

References 23 publications

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“…First, each component was Cancer treated as a separate variable (Model 3-1); then, a composite score for the ''adequacy of human resources'' was treated as a single variable (Model 3-2). Independent variables that were included in the multivariate analysis were selected based on a literature review, 8,15,16,[22][23][24] expert opinion, and statistical significance from the bivariate analyses. Likelihood ratio tests were performed to examine model fits.…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30][31][32][33] Consistent with previous studies, our pain management outcomes depended on average pain at admission 22,34 and patient age. 23,24,34 Higher pain scores at admission were associated positively with the degree of pain reduction in absolute value but were associated negatively with the achievement of adequate pain control. In other words, it is difficult to reduce severe pain to an adequate level, although it can be eliminated a fair amount.…”

Section: Original Articlementioning

confidence: 98%

“…Our multilevel modeling included patient-level and organizational-level factors that are known to affect pain control. Patient-level variables were selected based on literature review and data availability and included average pain at admission, 22 patient age, 23,24 and performance status. 23,24 Organizational-level variables included type of services and items from ''the adequacy of the human resource'' domain of the evaluation criteria for the designation program.…”

Section: Conceptual Framework and Independent Variablesmentioning

confidence: 99%

“…Patient-level variables were selected based on literature review and data availability and included average pain at admission, 22 patient age, 23,24 and performance status. 23,24 Organizational-level variables included type of services and items from ''the adequacy of the human resource'' domain of the evaluation criteria for the designation program. This domain was designed to evaluate the multidisciplinary composition and training adequacy based on the Korean Standard of Hospice and Palliative Care 12 and consisted of staffing levels and palliative care training status of physicians, nurses, and social workers and staffing levels of clergy and volunteers.…”

Section: Conceptual Framework and Independent Variablesmentioning

confidence: 99%

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Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

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BACKGROUND:The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (b, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2012;118:5688-97.

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Section: Discussionmentioning

confidence: 99%

Section: Original Articlementioning

confidence: 98%

Section: Conceptual Framework and Independent Variablesmentioning

confidence: 99%

Section: Conceptual Framework and Independent Variablesmentioning

confidence: 99%

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Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

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“…9,[17][18][19] However, we have a limited understanding of the demographic, clinical, and health service factors that influence pain management, specifically opioid use, in persons with cancer at the end of life. The objectives of this study were to use a populationbased method to assess the use of opioid analgesics within the community among older persons with CRC in the six months before death and determine factors associated with the use of opioid analgesics in this population.…”

Section: Introductionmentioning

confidence: 99%

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

Fisher

Urquhart

Johnston

2013

Journal of Pain and Symptom Management

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Context-Prescription of opioid analgesics is a key component of pain management among persons with cancer at the end of life.Objectives-To use a population-based method to assess the use of opioid analgesics within the community among older persons with colorectal cancer (CRC) before death and determine factors associated with the use of opioid analgesics.Methods-Data were derived from a retrospective, linked administrative database study of all persons who were diagnosed with CRC between January 1, 2001 and December 31, 2005 in Nova Scotia, Canada. This study included all persons who 1) were 66 years or older at the date of diagnosis; 2) died between January 1, 2001 and April 1, 2008; and 3) resided in health districts with formal palliative care programs (PCPs) (n = 657). Factors associated with having filled at least one prescription for a so-called "strong" opioid analgesic in the six months before death were examined using multivariate logistic regression.Results-In all, 36.7% filled at least one prescription for any opioid in the six months before death. Adjusting for all covariates, filling a prescription for a strong opioid was associated with enrollment in a PCP (odds ratio [OR] = 3.18, 95% CI = 2.05-4.94), residence in a long-term care facility (OR = 2.19, 95% CI = 1.23-3.89), and a CRC cause of death (OR = 1.75, 95% CI = 1.14-2.68). Persons were less likely to fill a prescription for a strong opioid if they were older (OR = 0.97, 95% CI = 0.95-0.99), male (OR = 0.59, 95% 0.40-0.86), and diagnosed less than six months before death (OR = 0.62, 95% CI = 0.41-0.93).Conclusion-PCPs may play an important role in enabling access to end-of-life care within the community.

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The Hard Task of Improving the Quality of Care at the End of Life

Morrison

Siu²,

Leipzig³

et al. 2000

Arch Intern Med

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Pain and Its Treatment in Outpatients with Metastatic Cancer

Abstract: Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.

Cited by 1,790 publications

References 23 publications

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Use of Opioid Analgesics Among Older Persons With Colorectal Cancer in Two Health Districts With Palliative Care Programs

The Hard Task of Improving the Quality of Care at the End of Life

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