Rapid Fire Session 2014 World Cancer Congress

Quality of pain management for end-of-life cancer patients receiving hospice and non-hospice care: Pain assessment and patient education (#448)

Mei-Ling Chen 1 , Yi-Ting Chen 2 , Shiew-Tzuh Tang 1 , Chen-Wen Ting 1 , Hung-Ming Wang 3
  1. Graduate Institute of Nursing, Chang Gung University, Tao-Yuan, Taiwan
  2. Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  3. Hematology Oncology, Chang Gung Memorial Hospital, Linko, New Taipei, Taiwan

Background: Relief of pain is one of the major goals of hospice/palliative care for cancer patients at the end-of-life. The hospice care in Taiwan has been promoted for more than 20 years. The impact of hospice care on quality of pain management has not been systematically evaluated.

Aim: The purpose of this study was to compare the quality of pain assessment and patient education in end-of-life cancer patients who received hospice care and who did not.

Methods: A retrospective chart review was conducted for cancer patients who died in 2011.  Patients were classified into hospice group if they received in-patient hospice care or hospice consultation/combined care in their last hospitalization. Six hundred and twenty-four randomly selected medical charts (312 for hospice group, 312 for non-hospice group) were screened for existence of pain during the last hospitalization. For patients who had pain, a set of quality indicators related to pain assessment, side effect assessment, and patient education were examined.

Results: Among 624 decedent cancer patients, 476 (76.3%) had pain during their last hospitalization (hospice = 265, non-hospice = 211). Compared to the non-hospice group, the hospice group had a higher achievement rate of using pain scale (64.5% vs. 24.9%), completing primary elements of comprehensive assessment (29.4% vs. 6.2%), assessing side effect of opioids for sedation (12.8% vs. 0.8%), nausea (32.2%vs. 6.0%), constipation (47.1& vs. 18.8%), and urinary retention (48.3 vs. 21.1%). The hospice group also showed a higher achievement rate in teaching patients about side effects of analgesics (66.4% vs. 56.4%), non-pharmacological interventions (27.2% vs. 14.2%), and cause of pain (17.0% vs. 6.6%).

Conclusions: Although the overall achievement rates for several quality indicators are unsatisfactory, hospice group did demonstrate a better quality in pain assessment and patient education. Continuous professional education and implement of pain management guideline are imperative.