The Effect of a Translating Research into Practice (TRIP)-Cancer Intervention on Cancer Pain Management in Older Adults in Hospice

Abstract

Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective This paper reports on the results of a Translating Research Into Practice intervention designed to promote the adoption of evidence-based pain practices for older adults with cancer in community-based hospice. Setting This IRB approved study was a cluster randomized trial implemented in sixteen Midwestern hospices. Methods Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence-based practices for the experimental sites was not significantly greater than control sites. Decrease in patient pain severity from baseline to post intervention in the experimental group was greater, however, the result was not statistically significant (p=0.1032). Conclusions Findings indicate a number of factors may impact implementation of multi-component interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest future study is needed on specific factors to target when implementing a community-based hospice intervention, including determining and measuring intervention fidelity prospectively.

Employment Status and Work-Related Difficulties among Family Members of Terminally Ill Patients Compared with the General Population

“…Caregivers with low monthly household incomes cannot afford to buy high-cost assistive care (Herr et al, 2012;Pantilat et al, 2012). Providing care for terminal cancer patients instead of working worsens the economic conditions of family caregivers with lower monthly incomes.…”

Evaluation of Evidence-based Nursing Pain Management Practice

“…The CPPI has been used to evaluate the documentation of EBPM for cancer pain by nurses in the hospice setting through a review of 11 EBPM indicators (Herr et al, 2010). Indicators found to be inconsistently documented were comprehensive pain assessment at time of admission, pain reassessment, monitoring of analgesic-induced side effects, bowel regimen with a presence of opioid order, review of pain treatment plan, and nonpharmacological therapies (Herr et al, 2010; Herr et al, 2012). …”

Evidence-Based Practice Beliefs and Behaviors of Nurses Providing Cancer Pain Management: A Mixed-Methods Approach

“…EBP, in the context of pain management, decreases resource use and patient length of stay and improves patient outcomes, including patient satisfaction, quality of life, and symptom distress (Chang, Hwang, & Kasimis, 2002; Green et al, 2010; Samuels, 2010). Although positive outcomes are associated with EBP, nurses are not consistent about adopting evidence-based pain management practices (Bell & Duffy, 2009; Herr et al, 2012; Idell, Grant, & Kirk, 2007; Samuels, 2010). …”