title: Impact of admission to hospice on pain intensity and type of pain therapies administered.
abstract: OBJECTIVE
  The primary aim of this study was to evaluate pain intensity changes in patients admitted to a hospice. The secondary objective was to evaluate whether these changes in pain were accompanied by modifications in therapies and drugs used to treat pain.
  
  
  METHODS
  This retrospective study included 96 patients admitted to a hospice for a minimum of 7 days who received pain therapy. An 11-point (0-10) numerical rating scale (NRS) was used to assess pain on a daily basis. A repeated measures analysis of variance was performed to evaluate pain intensity changes over time.
  
  
  RESULTS
  Mean ± SD pain NRS values of the entire group were 2.58 ± 2.61 on day 1 and 1.40 ± 1.72 on day 7 (P = 0.002). Restricting the analysis to patients with moderate to severe pain at the time of hospice admission, results were even more significant. In fact, mean ± SD pain NRS was 5.51 ± 1.24 for patients with pain ≥4 at admission and 1.76 ± 1.91 for the same patients after 7 days (P < 0.001). A significant increase in the number of patients receiving morphine was observed from day 1 to day 7 (24 to 41, respectively, P = 0.001) and in those receiving drugs via parenteral routes (subcutaneous or intravenous) from 10 to 27 (P = 0.002) CONCLUSIONS: Admission to a hospice and the hospice environment led to a significant reduction in reported pain intensity for the patients included in this study, mainly those with moderate to severe pain at the time of admission. This decrease in pain was accompanied by a significant increase in the use of morphine, especially via parenteral routes, but not by a higher mean equivalent daily dose of oral morphine per patient.
authors.affiliation: Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli, 40, 47014, Meldola, FC, Italy. elisabetta.petracci@irst.emr.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Petracci
authors.affiliation: Department of Pharmacy and Biotechnology, University of Bologna, Bologna, BO, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Nanni
authors.affiliation: Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Maltoni
authors.affiliation: Palliative Care Unit, Department of Geriatrics, Forlimpopoli Hospital, Forlimpopoli, FC, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Derni
authors.affiliation: Department of Pharmacy and Biotechnology, University of Bologna, Bologna, BO, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Campana
authors.affiliation: Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli, 40, 47014, Meldola, FC, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Scarpi
mesh_terms: D000368:Aged; D005260:Female; D017051:Hospice Care / Q000592:standards*; D006738:Hospices / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*
chemical_list: D009020:Morphine
keywords: Cancer pain; End of life; Pain assessment; Pain management