title: Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer.
abstract: Pain management is suboptimal in nursing homes.
  
  
  
  To estimate the extent to which receipt of hospice in nursing homes (NHs) increases the receipt of pain management for residents with cancer at the end of life.
  
  
  
  Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9064 matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided information on residents' pain prevalence and receipt of pain management (scheduled analgesics, as needed [pro re nata {PRN}] medication, nonpharmacologic interventions). We developed conditional logistic models to estimate the association between hospice use and pain management, stratified by self-reported and staff-assessed pain.
  
  
  
  We found that pain prevalence was higher in residents using hospice versus those without hospice (e.g., residents who self-reported pain: hospice: 59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6% in hospice users and nonusers, respectively). Hospice use was associated with receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95% CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31, 95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain management were similar in residents with staff-assessed pain.
  
  
  
  Untreated pain at the end of life among residents with cancer in NHs is unusual. Hospice is associated with increased pain management among those with documented pain.
authors.affiliation: Department of Quantitative Health Sciences; and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA. Electronic address: Jacob.Hunnicutt@umassmed.edu.
authors.forename: Jacob N
authors.initials: JN
authors.lastname: Hunnicutt
authors.affiliation: Department of Quantitative Health Sciences; and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.affiliation: Department of Quantitative Health Sciences; and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology / Q000628:therapy*; D009735:Nursing Homes / Q000706:statistics & numerical data; D010146:Pain / Q000453:epidemiology; D059408:Pain Management / Q000706:statistics & numerical data*; D010147:Pain Measurement; D015995:Prevalence; D057566:Self Report; D014481:United States
keywords: Nursing home; cancer; hospice; pain; pain management