Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Meagan, E.; Reid, M. Carrington; Inturrisi, Charles E.; Witkin, Lisa R.; Prigerson, Holly G.; Bao, Yuhua

doi:10.1016/j.jpainsymman.2016.05.020

Cited by 25 publications

(28 citation statements)

References 35 publications

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“…[15][16][17] Despite its importance, relatively little is known about symptom management medications received at EOL for Medicare beneficiaries outside the hospice setting. Prior studies describe medication use either in small clinical cohorts or in selected settings such as nursing homes, [18][19][20] hospitals, 21,22 hospice, 23 or palliative care centers common in Western Europe, the U.K., and Canada. [24][25][26] Population-based studies on specific palliative care services for home-based older adults are limited and have focused primarily on medication management for pain.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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Context.-Older adults with advanced lung cancer experience high symptom burden at end of life (EOL), yet hospice enrollment often happens late or not at all. Receipt of medications to manage symptoms in the outpatient setting, outside the Medicare hospice benefit, has not been described. Objectives.-We examined patterns of symptom management medication receipt at EOL for older adults who died of lung cancer. Methods.-This retrospective cohort used the Surveillance, Epidemiology, and End Results-Medicare database to identify decedents diagnosed with lung cancer at age 67 years and older between January 2008 and December 2013 who survived six months and greater after diagnosis. Using Medicare Part B and D claims, we identified monthly receipt of outpatient medications for symptomatic management of pain, emotional distress, fatigue, dyspnea, anorexia, and nausea/ vomiting. Multivariable logistic regression estimated associations between medication receipt and patient demographic characteristics, comorbidity, and concurrent therapy. Results.-Of the 16,246 included patients, large proportions received medications for dyspnea (70.7%), pain (62.5%), and emotional distress (49.4%), with lower prevalence for other symptoms. Medication receipt increased from six months to one month before death. Women and dual Medicaid enrolled were more likely to receive medications for pain, emotional distress, dyspnea, and nausea/vomiting. Receipt of symptom management medications decreased with increasing age and racial/ethnical minorities. Conclusion.-Symptom management medication receipt was common and increasing toward EOL. Lower use by males, older adults, and nonwhites may reflect poor access or poor patientprovider communication. Further research is needed to understand these patterns and assess adequacy of symptom management in the outpatient setting.

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Section: Introductionmentioning

confidence: 99%

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Saphire¹,

Prsic²,

Canavan³

et al. 2020

Journal of Pain and Symptom Management

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“…We believe this is related to the fact that pain is being recognized as a common symptom affecting people at the end of life. It is also recognized that pain assessment and management practices undertaken by healthcare professionals have direct implications for pain control [35]. It also seems that the usage of symptom assessment scales can improve the early detection and management of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Received in the Last Months of Life in Portugal: A Systematic Review

Pereira¹,

Ferreira²,

Martins

2019

Healthcare

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Background: While evidence demonstrates that end-of-life care practices vary across countries, there is still a lack of evidence regarding the healthcare that is received by adult individuals in the last months of life in Portugal. Methods: This is a systematic review that aims to examine the evidence published until 2019 regarding the healthcare received by adult individuals in the last months of life in Portugal. Results: Nine studies were included in this review. All of these were quantitative and retrospective studies, used patient records as the source of information, and were conducted in hospital settings. The time frame analysis before death ranged from 48 h to 3 months. The majority of the studies focused on the physical aspects of care, such as physical needs assessment and symptom management, prescribed medication, and invasive interventions. No evidence was found regarding spiritual, psychological, social or cultural needs. Conclusion: Although using patient records as a source of information may introduce a bias, this study indicates that there is a greater emphasis on the physical aspects of care and less on the psychological, spiritual or social aspects of care received by adult individuals in their last months of life in Portugal.

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“…It is recommended that several clinically-relevant factors be considered to inform optimal pain treatment options and ongoing management. 3,16 These factors include the quality of pain, site, severity, and presence. 3,17,18 Quality of pain refers to the various descriptions of pain sensations that a patient may experience (e.g., aching, burning, shooting, stabbing).…”

Section: Literature Reviewmentioning

confidence: 99%

“…3,16 These factors include the quality of pain, site, severity, and presence. 3,17,18 Quality of pain refers to the various descriptions of pain sensations that a patient may experience (e.g., aching, burning, shooting, stabbing). As pain can be experienced from multiple sites with differing levels of severity, comprehensive pain assessments which include this information are necessary to properly manage pain.…”

Section: Literature Reviewmentioning

confidence: 99%

“…1 An estimated 50%-66% of hospice patients experience pain as a significant symptom. 2 -4 A primary goal of hospice care is to maximize patient quality of life, in part, by minimizing pain-related distress. 5 Identifying pain within this population is important because hospice patients and their caregivers may experience heightened distress if pain symptoms are not reduced to a tolerable level.…”

Section: Introductionmentioning

confidence: 99%

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The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers

Ware

Cagle

2020

Am J Hosp Palliat Care

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Pain is a multidimensional symptom frequently experienced by hospice patients that is physical, psychological, social, emotional, and spiritual. Medicare regulations require hospices to complete a psychosocial assessment with content such as patient/family adjustment to illness. Furthermore, pain barriers such as concerns about addiction, and fatalism are recognized impediments to high quality pain management. National data concerning whether hospice social workers are paying attention to issues related to patient pain is minimal. Addressing this gap, we randomly sampled 248 hospices nationally and requested a blank copy of their social work psychosocial assessment and reviewed its pain-related content. A total of 105 hospices (response rate 42.3%) provided an assessment for review. Descriptive statistics summarize agency characteristics and whether pain assessment content and pain barrier content were present. Analyses examined whether pain assessment content was included based on agency characteristics. Of the 105 participating agencies, most were non-profit (60%) and located in the South (30.5%). Less than half (47.6%) of the agencies included pain assessment content in their assessment. No associations were observed between having pain assessment content and agency characteristics. None of the assessments included content about 3 barriers to pain management: tolerance, overdose, stigma, and fatalism. Few agencies included other barriers to pain management: addiction (1%), burden (1%), non-adherence (3.8%) and stoicism (18.1%). Agencies which had pain assessment content mostly included other dimensions of pain: psychological (80%), emotional (74%), and social (78%). Hospice social workers can do more to assess and address pain concerns—especially psychological, social, and emotional dimensions.

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Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.

Cited by 25 publications

References 35 publications

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Patterns of Symptom Management Medication Receipt at End-of-Life Among Medicare Beneficiaries With Lung Cancer

Healthcare Received in the Last Months of Life in Portugal: A Systematic Review

The Assessment of Pain and Barriers to Pain Management: A Content Analysis From a National Sample of Hospice Psychosocial Assessments Completed by Social Workers

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