Kara E Bischoff1, David L O'Riordan2, Kristyn Fazzalaro3, Anne Kinderman4, Steven Z Pantilat2. 1. Palliative Care Program, University of California, San Francisco, San Francisco, California, USA. Electronic address: kara.bischoff@ucsf.edu. 2. Palliative Care Program, University of California, San Francisco, San Francisco, California, USA. 3. Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA. 4. Palliative Care Program, University of California, San Francisco, San Francisco, California, USA; San Francisco General Hospital, San Francisco, California, USA.
Abstract
CONTEXT: Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. OBJECTIVE: Identify characteristics associated with pain and pain improvement among inpatients referred to PC. METHODS: Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. RESULTS: Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003). CONCLUSION: Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement.
CONTEXT: Pain is a common and distressing symptom. Pain management is a core competency for palliative care (PC) teams. OBJECTIVE: Identify characteristics associated with pain and pain improvement among inpatients referred to PC. METHODS: Thirty-eight inpatient PC teams in the Palliative Care Quality Network entered data about patients seen between December 12, 2012 and March 15, 2016. We examined patient and care characteristics associated with pain and pain improvement. RESULTS: Of patients who could self-report symptoms, 30.7% (4959 of 16,158) reported moderate-to-severe pain at first assessment. Over 40% of these patients had not been referred to PC for pain. Younger patients (P < 0.0001), women (P < 0.0001), patients with cancer (P < 0.0001), and patients in medical/surgical units (P < 0.0001) were more likely to report pain. Patients with pain had higher rates of anxiety (P < 0.0001), nausea (P < 0.0001), and dyspnea (P < 0.0001). Sixty-eight percent of patients with moderate-to-severe pain improved by the PC team's second assessment within 72 hours; 74.7% improved by final assessment. There was a significant variation in the rate of pain improvement between PC teams (P < 0.0001). Improvement in pain was associated with improvement in anxiety (OR = 2.9, P < 0.0001) and dyspnea (OR = 1.4, P = 0.03). Patients who reported an improvement in pain had shorter hospital length-of-stay by two days (P = 0.003). CONCLUSION:Pain is common among inpatients referred to PC. Three-quarters of patients with pain improve and improvement in pain is associated with other symptom improvement. Standardized, multisite data collection can identify PC patients likely to have marked and refractory pain, create benchmarks for the field, and identify best practices to inform quality improvement.
Authors: Nneka N Ufere; David L O'Riordan; Kara E Bischoff; Angela K Marks; Nwamaka Eneanya; Raymond T Chung; Vicki Jackson; Steven Z Pantilat; Areej El-Jawahri Journal: J Pain Symptom Manage Date: 2019-07-19 Impact factor: 3.612
Authors: Allyson Cook Chapman; Joseph A Lin; Julien Cobert; Angela Marks; Jessica Lin; David L O'Riordan; Steven Z Pantilat Journal: J Pain Symptom Manage Date: 2022-06 Impact factor: 5.576