Practice patterns of hospice medical directors in a Midwestern state.

This study of hospice medical directors was conducted in a Midwestern state with the help of the state hospice organization in the summer of 1998. The hospice programs in this state were young and relatively small. While having practiced medicine for many years, the majority of hospice medical directors had been affiliated with a hospice program for less than five years. The programs reported little orientation or continuing education for their physician leaders. Pain management practices were analyzed and compared with practice standards in the hospice pain management literature. Attitudes on the scheduled dosing of opioids, use of adjuvant medications for bone pain, the assessment of pain by the patient, and physician comfort with high doses of morphine are consistent with suggested standards and attitudes in the literature. Practice patterns that differed with the literature included choice of drugs, routes of administration, and dosing issues. Opportunities exist to improve care and lower cost.