Cancer pain assessment and management recommendations by hospice nurses

Pain is often the most prevalent symptom among cancer patients referred to hospice or palliative care programs. Tills study was designed to use perfor mance-based testing to evaluate the skills of hospice nurses in assessing t he severe pain of a cancer patient and the pain management recommendations they would present to the patient's primary care physician. Twenty-seven ho spice nurses (ranging in experience from 1 month to 10 years) were presente d with the same standardized patient with cancer pain. In Part A (7 minutes ), one of the investigators checked for predetermined behaviors as the nurs es performed the clinical pain assessment. In Part B (7 minutes), the nurse s answered questions regarding their recommendations for pain management fo r the patient seen in Part A. In the admission pain assessment, hospice nur ses did well in assessing pain intensity (85 %), pain location (70 %), and pain-relieving factors (59%). However, only 48% of the nurses adequately as sessed the pain onset, and only 44 % adequately assessed other symptoms the patient might be experiencing. In Part B, 96% of the nurses recommended op ioids, 96% recommended the oral route of administration, and 82 % recommend ed regular dosing of the opioids. Fifty-six percent of nurses included a br eakthrough medication in their analgesic recommendations. All of the hospic e nurses treated the patient's fear of addiction in an appropriate manner; and 93 % of the nurses recommended increasing the patient's opioid dosage t o treat the persisting pain problem. There were no significant differences among nurses with regard to length of time as a hospice nurse or hospice ce rtification on any of the items in either Part A or Part B. Most practicing hospice nurses were judged to be competent in the assessment and managemen t of the severe pain of the standardized cancer patient, although some defi cits were noted. Regular oral opioids were the analgesics of choice. Co-ana lgesics were rarely recommended. (C) U.S. Cancer Pain Relief Committee, 199 9.