Improving pain outcomes of hospice patients with cancer.

PURPOSE/OBJECTIVES To evaluate the success of a multifaceted, hospicewide, nurse-focused pain-management intervention for improving patient pain outcomes. DESIGN Comparative, descriptive. SETTING A large, nonprofit hospice that primarily provides home care. SAMPLE Two samples were included in the study. One sample (n = 47) was from a study completed in 1995 before the intervention, and one (n = 255) was from a study completed in 1997 after the intervention. All patients had been diagnosed with cancer and were alert and able to self-report. METHODS Secondary analysis of data that were collected as part of two quality-of-life studies. The four-part intervention included intensive pain-management education for the nurses, development and implementation of pain-management policies and procedures, changes in pain assessment and management documentation, and development and use of quality assurance monitors by the nursing staff. MAIN RESEARCH VARIABLES Pain at its worst, pain relief, and quality of life. FINDINGS Adjusted mean pain-relief scores were significantly lower in 1995 (X = 5.8) than in 1997 (X = 8.4). In 1995, 43% of patients reported pain relief at a level of 5 or less (on a 0-10 scale). This number dropped to 10% by 1997. Adjusted mean pain-at-its-worst scores were significantly lower in 1997 (X = 6.1) than in 1995 (X = 6.7). Pain relief was found to be positively correlated (r = 0.41-0.51) with quality of life in both samples. CONCLUSIONS The hospicewide pain-management intervention was effective. IMPLICATIONS FOR NURSING PRACTICE Through careful study and multifaceted nurse-focused interventions, pain outcomes of hospice patients with cancer can be improved.