Pharmacologic Pain Management for Cancer Patients at Home

Knowledge and Perceived Competence of Home Care Nurses in Pain Management

“…Lack of knowledge has been demonstrated in the following areas: equianalgesic dosing; duration of action of morphine; general principles of chronic pain management; nonpharmacologic interventions; differences between acute and chronic pain; tolerance and addiction; anatomy and physiology of pain; and opioid pharmacology. [15][16][17][18][19][20][21] Recent studies have reported on the treatment of breakthrough pain at home, 23 home infusion therapy, 24 home use of methadone treatment, 25 continuous intrathecal morphine infusion for refractory cancer pain, 26 transdermal fentanyl, 27 and patient-controlled analgesia (PCA). 28 In addition, home care nurses are expected to treat a wide range of patients rang-ing from the elderly [29][30][31] to children.…”

“…The home care nurse is expected to provide appropriate teaching of pain and symptom management, 40 high quality communication, and psychosocial support to families. 41,42 When successful, home pain management improves patients' sense of autonomy and range of self-care behaviors [24][25][26][27]32 throughout the disease trajectory. But if home care pain management fails, patients may be more likely to require hospitalization and experience loss of control.…”

“…5 This is problematic, given the expectation that the home care nurse will advocate for best current pain relief techniques 17 and pro-vide frequent reassurance to families that effective pain control can be achieved. 26 In a study of 190 elderly cancer patients in Britain, home care nurses reported high degrees of helplessness when treatment failed to alleviate pain. Study findings highlight the need for a strong focus on pain and provision of psychosocial support during training for these nurses.…”