title: Assessing and treating pain in hospices: current state of evidence-based practices.
abstract: 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.
authors.affiliation: College of Nursing, University of Iowa, Iowa City, Iowa 52242, USA. keela-herr@uiowa.edu
authors.forename: Keela
authors.initials: K
authors.lastname: Herr
authors.forename: Marita
authors.initials: M
authors.lastname: Titler
authors.forename: Perry
authors.initials: P
authors.lastname: Fine
authors.forename: Sara
authors.initials: S
authors.lastname: Sanders
authors.forename: Joe
authors.initials: J
authors.lastname: Cavanaugh
authors.forename: John
authors.initials: J
authors.lastname: Swegle
authors.forename: Chris
authors.initials: C
authors.lastname: Forcucci
authors.forename: Xiongwen
authors.initials: X
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000451:nursing*; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000451:nursing*; D059408:Pain Management; D010147:Pain Measurement / Q000451:nursing* / Q000592:standards; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
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