Management of Severe Pain in Terminally Ill Patients at Home: An Evidence-Based Strategy.

The purpose of this article is to describe current evidence-based strategies to manage severe pain in patients living with terminal illnesses. A comprehensive pain assessment is a critical step in the initial development of a pain management plan and for ongoing evaluation of patients' pain. Although we have many effective clinical tools available for pain assessment, they are not always used consistently, which can negatively affect the pain management plan. Home care and hospice nurses need to be consistent in using the tools and documenting the patient's pain level and response to the pain management plan. Patients and caregivers have concerns and fears surrounding medication use, particularly with narcotic analgesics. It is vital that nurses provide thorough patient-centered teaching about medications to help address these concerns. Research has found that nurses who also provided validation to patients and families regarding their concerns, followed by education, were the most effective.

[1]  G. Demiris,et al.  Communicating Caregivers' Challenges With Cancer Pain Management: An Analysis of Home Hospice Visits. , 2018, Journal of pain and symptom management.

[2]  G. Demiris,et al.  Pain Management Concerns From the Hospice Family Caregivers’ Perspective , 2018, The American journal of hospice & palliative care.

[3]  D. Tibboel,et al.  The Rotterdam Elderly Pain Observation Scale (REPOS) is reliable and valid for non-communicative end-of-life patients , 2018, BMC Palliative Care.

[4]  M. C. Reid,et al.  Pain Assessment, Management, and Control Among Patients 65 Years or Older Receiving Hospice Care in the U.S. , 2016, Journal of pain and symptom management.

[5]  D. McGuire,et al.  Pain Assessment in Noncommunicative Adult Palliative Care Patients. , 2016, The Nursing clinics of North America.

[6]  C. Depp,et al.  Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. , 2016, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[7]  Bih-O Lee,et al.  Mediating Effect of Family Caregivers' Hesitancy to Use Analgesics on Homecare Cancer Patients' Analgesic Adherence. , 2015, Journal of pain and symptom management.

[8]  J. Wilbur,et al.  Effect of hospice nonprofessional caregiver barriers to pain management on adherence to analgesic administration recommendations and patient outcomes. , 2015, Pain management nursing : official journal of the American Society of Pain Management Nurses.

[9]  D. Tibboel,et al.  Medication use during end-of-life care in a palliative care centre , 2015, International Journal of Clinical Pharmacy.

[10]  J. Lynn,et al.  Symptom Trends in the Last Year of Life From 1998 to 2010 , 2015, Annals of Internal Medicine.

[11]  S. Stiel,et al.  Subcutaneous administration of drugs in palliative care: results of a systematic observational study. , 2014, Journal of pain and symptom management.

[12]  P. Fine,et al.  Alternative routes to oral opioid administration in palliative care: a review and clinical summary. , 2014, Pain medicine.

[13]  S. R. Cohen,et al.  Flying Blind: Sources of Distress for Family Caregivers of Palliative Cancer Patients Managing Pain at Home , 2014, Journal of psychosocial oncology.

[14]  Jennifer A Kowalkowski,et al.  A Systematic Review of the Prevalence of Signs of Impending Death and Symptoms in the Last 2 Weeks of Life , 2013, The American journal of hospice & palliative care.

[15]  I. Higginson,et al.  Heterogeneity and changes in preferences for dying at home: a systematic review , 2013, BMC Palliative Care.

[16]  Laura M. Holdsworth,et al.  A retrospective analysis of preferred and actual place of death for hospice patients. , 2010, International journal of palliative nursing.

[17]  S. Ruder.  7 Tools to Assist Hospice and Home Care Clinicians in Pain Management at End of Life , 2010, Home healthcare nurse.

[18]  B. Gomes,et al.  Time to get it right: are preferences for place of death more stable than we think? , 2010, Palliative medicine.

[19]  G. Pasternak,et al.  Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. , 2009, The journal of pain : official journal of the American Pain Society.

[20]  T. Morita,et al.  Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus. , 2003, Journal of pain and symptom management.

[21]  Lauren W. Cohen,et al.  EMPOWER: an intervention to address barriers to pain management in hospice. , 2015, Journal of pain and symptom management.