Assessing and treating pain in hospices: current state of evidence-based practices.

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Journal of pain and symptom management, ISSN: 1873-6513, Vol: 39, Issue: 5, Page: 803-19

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Herr, Keela; Titler, Marita; Fine, Perry; Sanders, Sara; Cavanaugh, Joe; Swegle, John; Forcucci, Chris; Tang, Xiongwen
Elsevier BV
Nursing; Medicine; Neoplasms -- Nursing; Pain Measurement -- Nursing; Pain -- Diagnosis; Pain -- Nursing; Age Factors; Aged; 80 and Over; Analgesics -- Therapeutic Use; Analgesics; Opioid -- Therapeutic Use; Female; Guideline Adherence; Hospice Care; Hospices; Human; Male; Medical Practice; Evidence-Based; Neoplasms -- Complications; Nursing Assessment; Pain Measurement -- Standards; Pain -- Etiology; Pain -- Therapy; Practice Guidelines; Questionnaires; Research; Resource Databases
article description
The aim of this study was to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index, a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of those key evidence-based practices (EBPs) that were applicable to their situations. When examining individual practices, most of the patients had their pains assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps, including additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the pain treatment plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by increases in pain medication (15.8%); monitoring of analgesic-induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both nonpharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed, or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices.