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    Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer

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    Authors
    Hunnicutt, Jacob N.
    Tjia, Jennifer
    Lapane, Kate L.
    UMass Chan Affiliations
    Clinical and Population Health Research Program, Graduate School of Biomedical Sciences
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2017-03-01
    Keywords
    UMCCTS funding
    Nursing home
    cancer
    hospice
    pain
    pain management
    Geriatrics
    Health Services Administration
    Pain Management
    Palliative Care
    Translational Medical Research
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    Link to Full Text
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5337160/
    Abstract
    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.
    Source

    J Pain Symptom Manage. 2017 Mar;53(3):561-570. doi: 10.1016/j.jpainsymman.2016.10.369. Epub 2016 Dec 29. Link to article on publisher's site

    DOI
    10.1016/j.jpainsymman.2016.10.369
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50528
    PubMed ID
    28042063
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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jpainsymman.2016.10.369
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