Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer
Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer
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DOI：
10.1016/j.jpainsymman.2016.10.369
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发表时间：
2017-03-01
影响因子：
4.7
通讯作者：
Lapane, Kate L.
中科院分区：
文献类型：
--
作者：
Hunnicutt, Jacob N.;Tjia, Jennifer;Lapane, Kate L.
上下文。护理之家的疼痛管理并不理想。评估在养老院接受临终关怀(NHS)在多大程度上增加了癌症患者临终前接受疼痛治疗的机会。研究参与者包括患有癌症的联邦医疗保险受益人，他们是2011-2012年生命的最后90天内的NH居民(n=78,160)。根据设施、疼痛评估类型(自我报告/工作人员评估)和死亡周(9064个匹配的阶层，16,968个独特的居民)，在临终关怀中痛苦的居民与喜欢没有临终关怀的居民进行匹配。最低数据集3.0提供了关于居民疼痛患病率和疼痛管理接受情况的信息(按需计划镇痛剂、[PRN}]药物、非药物干预)。我们开发了条件Logistic模型来评估临终关怀使用和疼痛管理之间的关联，根据自我报告和工作人员评估的疼痛进行分层。我们发现，使用临终关怀的居民的疼痛患病率高于不使用临终关怀的居民(例如，自我报告疼痛的居民：临终关怀：59.9%，95%CI=59.3%-60.5%；非临终关怀：50.0%，95%CI=49.4%-50.6%)。在配对分析中，未治疗的疼痛并不常见(在临终关怀使用者和非使用者中，自我报告的疼痛分别为2.9%和5.6%)。临终关怀的使用与接受计划止痛药(自我报告：调整后的优势比=1.85，95%CI=1.73-1.971)和PRN药物(自我报告：调整后的优势比=1.31，95%CI=1.20-1.43)相关。在有工作人员评估的疼痛的住院医生中，疼痛的患病率以及临终关怀和疼痛管理之间的关联是相似的。在英国国民健康保险制度中，癌症患者在生命末期未经治疗的疼痛是不寻常的。临终关怀与那些有记录的疼痛的人增加疼痛管理有关。(C)2016年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. Pain management is suboptimal in nursing homes.Objectives. To estimate the extent to which receipt of hospice in nursing homes (NHs) increases the receipt of pain management for residents with cancer at the end of life.Methods. Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9064 matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided information on residents' pain prevalence and receipt of pain management (scheduled analgesics, as needed [ pro re nata {PRN}] medication, nonpharmacologic interventions). We developed conditional logistic models to estimate the association between hospice use and pain management, stratified by self-reported and staff-assessed pain.Results. We found that pain prevalence was higher in residents using hospice versus those without hospice (e.g., residents who self-reported pain: hospice: 59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6% in hospice users and nonusers, respectively). Hospice use was associated with receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95% CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31, 95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain management were similar in residents with staff-assessed pain.Conclusion. Untreated pain at the end of life among residents with cancer in NHs is unusual. Hospice is associated with increased pain management among those with documented pain. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.