Stephen J Stapleton1, Brenda W Dyal, Andrew D Boyd, Marie L Suarez, Miriam O Ezenwa, Yingwei Yao, Diana J Wilkie. 1. Author Affiliations: Department of Nursing, Concordia College (Dr Stapleton), Moorhead, Minnesota; Department of Biobehavioral Nursing Science, College of Nursing, University of Florida (Drs Dyal, Ezenwa, Yao, and Wilkie), Gainesville; and Department of Biomedical and Health Information Sciences, College of Applied Health Sciences (Dr Boyd), and Department of Biobehavioral Nursing Science, College of Nursing (Dr Suarez), University of Illinois Chicago.
Abstract
BACKGROUND: Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. OBJECTIVE: The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. METHODS: This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAIN Report It, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index. RESULTS: The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence ( P < .001). CONCLUSION: Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed. IMPLICATION FOR PRACTICE: Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.
BACKGROUND: Adherence to prescribed analgesics for patients seriously ill with cancer pain is essential for comfort. OBJECTIVE: The objective of this study was to determine the analgesic adherence in seriously ill patients with cancer and its association with clinical and demographic characteristics. METHODS: This is a cross-sectional study. At home, 202 patients with cancer (mean age, 59.9 ± 14.2 years; 58% female, 48% Black, and 42% White) admitted to hospice/palliative care completed measures on a pen tablet: PAIN Report It, Symptom Distress Scale, mood state item, Pittsburgh Sleep Quality Index item, and Pain Management Index. RESULTS: The mean current pain intensity was 4.4 ± 2.9, and the mean worst pain in the past 24 hours was 7.2 ± 2.7. More than one-half of participants were not satisfied with their pain level (54%) and reported their pain was more intense than they wanted to tolerate for 18 hours or longer in the last 24 hours (51%). Only 12% were not prescribed analgesics appropriate for the intensity of their pain. Adherence rates were variable: nonsteroidal anti-inflammatory drugs (0.63 ± 0.50), adjuvants (0.93 ± 0.50), World Health Organization step 2 opioids (0.63 ± 0.49), and step 3 opioids (0.80 ± 0.40). With setting/clinical/demographic variables in the model, dose intervals of less than 8 hours were associated with less adherence ( P < .001). CONCLUSION: Little progress has been made toward improving analgesic adherence even in settings providing analgesics without cost. Research focused on targeting analgesic dose intervals and barriers not related to cost is needed. IMPLICATION FOR PRACTICE: Dose intervals of 8 hours or longer were significantly associated with higher adherence rates; therefore, use of longer-acting analgesics is one strategy to improve pain control at the end of life.
Authors: Brenda W Dyal; Miriam O Ezenwa; Yingwei Yao; Robert E Molokie; Zaijie J Wang; Samir K Ballas; Marie L Suarez; Diana J Wilkie Journal: Patient Educ Couns Date: 2019-08-17
Authors: Diana J Wilkie; Young Ok Kim; Marie L Suarez; Colleen M Dauw; Stephen J Stapleton; Geraldine Gorman; Judith Storfjell; Zhongsheng Zhao Journal: J Palliat Med Date: 2009-07 Impact factor: 2.947
Authors: Wendy H Oldenmenger; Michael A Echteld; Rianne de Wit; Peter A E Sillevis Smitt; Dirk L Stronks; Gerrit Stoter; Carin C D van der Rijt Journal: J Pain Symptom Manage Date: 2007-08-20 Impact factor: 3.612
Authors: Diana J Wilkie; Yingwei Yao; Miriam O Ezenwa; Marie L Suarez; Brenda W Dyal; Anayza Gill; Theresa Hipp; Robert Shea; Jacob Miller; Karen Frank; Nargis Nardi; Michael Murray; Julie Glendenning; Jessica Perez; Jesus D Carrasco; David Shuey; Veronica Angulo; Timothy McCurry; Joanna Martin; Adrienne Butler; Zaijie Jim Wang; Robert E Molokie Journal: J Pain Symptom Manage Date: 2019-11-09 Impact factor: 3.612