Experience of Barriers to Pain Management in Patients Receiving Outpatient Palliative Care

Kwon, Jung Hye; Hui, David; Chisholm, Gary B.; Hong, Woo Taik; Nguyen, Linh M; Bruera, Éduardo

doi:10.1089/jpm.2012.0610

Cited by 27 publications

(23 citation statements)

References 27 publications

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“…Indeed, nonwhite patients tended to have communication problems, which might have led to their receiving less aggressive care. These findings are similar to the results of our previous study of cancer pain management, in which nonwhite patients showed higher pain management barriers than white patients (p=0.02) [ 25 ].…”

Section: Discussionsupporting

confidence: 91%

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer

et al. 2014

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PurposeThe response to haloperidol as a first-line neuroleptic and the pattern of neuroleptic rotation after haloperidol failure have not been well defined in palliative care. The purpose of this study was to determine the efficacy of haloperidol as a first-line neuroleptic and the predictors associated with the need to rotate to a second neuroleptic.Materials and MethodsWe conducted a retrospective review of the charts of advanced cancer patients admitted to our acute palliative care unit between January 2012 and March 2013. Inclusion criteria were a diagnosis of delirium and first-line treatment with haloperidol.ResultsAmong 167 patients with delirium, 128 (77%) received only haloperidol and 39 (23%) received a second neuroleptic. Ninety-one patients (71%) who received haloperidol alone improved and were discharged alive. The median initial haloperidol dose was 5 mg (interquartile ranges [IQR], 3 to 7 mg) and the median duration was 5 days (IQR, 3 to 7 days). The median final haloperidol dose was 6 mg (IQR, 5 to 7 mg). A lack of treatment efficacy was the most common reason for neuroleptic rotation (87%). Significant factors associated with neuroleptic rotation were inpatient mortality (59% vs. 29%, p=0.001), and being Caucasian (87% vs. 62%, p=0.014). Chlorpromazine was administered to 37 patients (95%) who were not treated successfully by haloperidol. The median initial chlorpromazine dose was 150 mg (IQR, 100 to 150 mg) and the median duration was 3 days (IQR, 2 to 6 days). Thirteen patients (33%) showed reduced symptoms after the second neuroleptic.ConclusionNeuroleptic rotation from haloperidol was only required in 23% of patients with delirium and was associated with inpatient mortality and white race.

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Section: Discussionsupporting

confidence: 91%

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer

et al. 2014

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“…20 Barriers to pain relief are reported more commonly for nonwhite patients. 21,22 Studies also suggest that people who are socioeconomically disadvantaged may not be fully believed when they are reporting pain, and they may receive less than adequate pain control. 23,24 The underlying causes of these disparities include interactions between the patient and the clinician along with environmental factors.…”

Section: Introductionmentioning

confidence: 99%

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Paice

2018

Cancer

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Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.

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“…Kwon et al [17] state that pain is a common symptom that diminishes the quality of life of the patients, however, it still is not sufficiently addressed. Eyigor [18] in his study observes that 34.3% of surveyed medical students believe that the use of opioids was insufficient in cancer patients, whereas 54.3% of them stated that pain management was ting the competent persons who would be able to provide assistance at any time.…”

Section: Discussionmentioning

confidence: 99%

Holistic treatment of the patient in palliative care – The nurses view

Filej

Kaučič

Žvanut

et al. 2016

Pielegniarstwo XXI Wieku / Nursing in the 21st Century

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Introduction. Man is a unique, unrepeatable whole in space and time and that is why he requires a holistic treatment, taking into account physical, psychological, social and spiritual factors. The balanced factors can ensure human well-being and his quality of life. Integrated treatment is especially important for patients in palliative care, which was the basic starting point of our research. In our research we wanted to establish whether the patients in palliative care are treated holistically from the perspective of the nurses and where are the specific aspects of palliative care (psychological, physical, social and spiritual) more visible - in the hospitals or in the home environment.Material and methods. The questionnaire survey was based on the empirical quantitative methodology; a descriptive causal non-experimental method was used. The number of the included sample was 127 nurses (92 hospital nurses, 35 community nurses). To test the differences between the groups (hospital, community nursing), the single factor analysis of variance was used. All the research participants were ensured anonymity and they had the right to withdraw from the study before or during the questionnaire completion.Results. The physical aspect of the treatment was statistically significantly higher assessed by nurses in a hospital setting (̅χ =3.83; s=1.012; p=0.042). The psychological and spiritual aspects were higher assessed in community nursing setting and social aspect in hospital setting.Conclusions. Our research has highlighted the shortcomings of the holistic approach in palliative care. Nurses need in-depth knowledge and skills as well as practice within each holistic domain to perform quality treatment of palliative patients.

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Experience of Barriers to Pain Management in Patients Receiving Outpatient Palliative Care

Cited by 27 publications

References 27 publications

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer

Frequency and Outcome of Neuroleptic Rotation in the Management of Delirium in Patients with Advanced Cancer

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Holistic treatment of the patient in palliative care – The nurses view

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