Severe pain at the end of life: a population-level observational study

Abstract

Background: Pain is a prevalent symptom at the end of life and negatively impacts quality of life. Despite this, little population level data exist that describe pain frequency and associated factors at the end of life. The purpose of this study was to explore the prevalence of clinically significant pain at the end of life and identify predictors of increased pain. Methods: Retrospective population-level cohort study of all decedents in Ontario, Canada, from April 1, 2011 to March 31, 2015 who received a home care assessment in the last 30 days of life (n = 20,349). Severe daily pain in the last 30 days of life using linked Ontario health administrative databases. Severe pain is defined using a validated pain scale combining pain frequency and intensity: daily pain of severe intensity. Results: Severe daily pain was reported in 17.2% of 20,349 decedents. Increased risk of severe daily pain was observed in decedents who were female, younger and functionally impaired. Those who were cognitively impaired had a lower risk of reporting pain. Disease trajectory impacted pain; those who died of a terminal illness (i.e. cancer) were more likely to experience pain than those with frailty (odds ratio 1.66). Conclusion: Pain is a common fear of those contemplating end of life, but severe pain is reported in less than 1 in 5 of our population in the last month of life. Certain subpopulations may be more likely to report severe pain at the end of life and may benefit from earlier palliative care referral and intervention.

COVID‐19 end‐of‐life care: symptoms and supportive therapy use in an Australian hospital

“…We also observed an increasing number of patients experiencing moderate to severe pain in the last 24-48 h of life, although this was less common (56.8%), compared to a recent large population study (69.7%). 18 While cough is one of the commonest presenting symptoms of COVID-19, 19 it was uncommon in this cohort of dying patients and the prevalence reduced with time.…”

End of life care needs in cancer patients at home: A retrospective study on clinical, geographical and socio-cultural differences

“…The primary outcome of the study was the number of health care services given to patients at home during the last 30 days of life [15]. The health services were considered as follows: the total number and content of the activities performed by physician and nurse, physician alone or nurse alone.…”

Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet

“…Denne studien viser ingen signifikant forskjell mellom den palliative omsorgen pasientene mottar, og dens subjektive betydning i dimensjonen MT, i aspektet koordinering og samarbeid og i 16 spørsmål. Vi kan derfor anse at pasientene har opplevd at den palliative omsorgen er i tråd med deres preferanser på områder som også andre har vist at har betydning: pleie og omsorg (Seow & Bainbridge, 2018), bli møtt med aerlighet og respekt (Virdun et al, 2015), ha valgmuligheter (Sandsdalen et al, 2015a) og få lindret smerter (Hagarty et al, 2020;Sarmento et al, 2017;Seow & Bainbridge, 2018;Vedel et al, 2014). Dette er også spørsmål der pasientene i vår studie har svart «helt trygg» / «ganske trygg».…”