An Intervention to Reduce Barriers to Effective Pain Management in Hospice

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DESCRIPTION (provided by applicant): Project Summary/Abstract Despite significant accomplishments in hospice care, many patients continue to experience substantial pain and discomfort in their final days of life. A number of key barriers to effective pain management in hospice have been identified that are psychosocial in nature, including erroneous beliefs about addiction and tolerance, reluctance to report pain for fear of being perceived as weak or drug-seeking, and lack of communication between patients, family caregivers, and providers. To help minimize the prevalence of discomfort during life threatening illness and improve administration of and adherence to pain treatments, researchers have called for systematic strategies to understand and address the concerns of patients and their family caregivers related to pain management. The proposed study responds to AHRQ's stated research priority to improve care at the end-of-life by testing the feasibility of an evidence-based educational intervention designed to address barriers to effective pain management in hospice. The study will use a cluster-randomized experimental design in four hospice agencies, wherein community dwelling patient-family pairs will be recruited for a total sample size of 240 patient-family pairs. Using a cost-effective train-the-trainer approach, hospice staff members in the experimental group will be trained to use a brief screening instrument, provide written material, and deliver an individualized verbal intervention to patient-family pairs upon admission into hospice care. The content of the intervention will address common myths and misconceptions about pain management and will be tailored to patients and families to cover pain-related topics that are relevant to them. Control subjects will receive standard hospice services. By providing hospice consumers with accurate and relevant information about pain and pain treatments, the proposed intervention is hypothesized to improve the management of patient pain. Hence, the aims of this project are to conduct the proposed intervention and: (1) evaluate intervention fidelity; (2) assess the feasibility of data collection; (3) provide initial data on efficacy and derive sample size estimates; and, (4) determine staff time and training costs. The results of this study will be used to refine the methods and provide sample size estimates for a larger definitive trial (an R01) to further investigate the efficacy and effectiveness of the intervention across diverse geographic regions and a broader sample of hospice providers. Findings from this study may also have implications for the use of psychosocial interventions in other healthcare environments interested in minimizing barriers to pain management. PUBLIC HEALTH RELEVANCE: Project Narrative This study tests the feasibility of an educational intervention designed to address barriers to effective pain management in hospice. The intervention targets hospice staff, patients, and family caregivers to confront common myths and misconceptions associated with pain management. By providing hospice providers and consumers with accurate and relevant information about pain and pain treatments, the proposed intervention is hypothesized to improve the management of patient pain.