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

TitlePain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S.
Publication TypeJournal Article
Year of Publication2016
AuthorsCea ME, M Reid C, Inturrisi C, Witkin LR, Prigerson HG, Bao Y
JournalJ Pain Symptom Manage
Date Published2016 11
KeywordsAged, Aged, 80 and over, Ethnic Groups, Female, Healthcare Disparities, Hospice Care, Hospices, Humans, Logistic Models, Male, Multivariate Analysis, Pain Management, Pain Measurement, Surveys and Questionnaires, United States

CONTEXT: Knowledge is limited regarding pain assessment and management practices, as well as pain-related outcomes in hospice care.

OBJECTIVES: To generate national estimates of pain assessment and management practices and outcomes of pain control among patients 65 years or older receiving hospice care in the U.S. and identify hospice discharge and agency characteristics predicting study outcomes.

METHODS: The 2007 National Home Health and Hospice Care Survey was analyzed. Multivariate logistic regressions were estimated to identify discharge and agency characteristics predicting guideline-concordant pain assessment and management practices and pain control outcomes.

RESULTS: A high percentage of discharges had pain assessment at admission (97%) and before discharge (93%); use of valid pain rating scales was relatively low (69% and 54% for first and last assessments, respectively). Almost 95% of patients received pain medication, but only 42% received nonpharmacologic therapies. About 70% of patients assessed with a valid pain scale saw improvement in the level of pain or remained free of pain from admission to discharge. Non-Hispanic blacks were less likely to have pain assessments, and Hispanics were less likely to receive opioid analgesics or to have pain-free status at discharge, compared with non-Hispanic whites. Patients receiving care from for-profit (vs. nonprofit) agencies were more likely to receive pain assessment with a valid scale before discharge but less likely to experience pain control or improvement.

CONCLUSION: Greater use of valid pain assessment scales and nonpharmacologic therapies constitutes areas for improvement in hospice care. Targeted interventions are needed to address disparities in pain care by patient race and/or ethnicity and agency ownership status.

Alternate JournalJ Pain Symptom Manage
PubMed ID27693900
PubMed Central IDPMC5473027
Grant ListP30 AG022845 / AG / NIA NIH HHS / United States
R35 CA197730 / CA / NCI NIH HHS / United States
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