Adequate pain management at end of life is a team effort

Inadequate management of pain in patients with terminal illness and those at the end of their lives exists because of knowledge deficits and misperceptions among patients, families, and healthcare providers, indicate the results of a study involving palliative nurses.

Barriers to effective pain management include the (in)experience of healthcare professionals, judgementalism, conflicts between family and patient as well as healthcare professionals, and fear.

Strategies to overcome these barriers include promoting effective communication among physicians, nurses, patients, and family, suggest Gloria Duke (University of Texas at Tyler, USA) and Kevin Jablonski (Mother Frances Hospital Winnsboro, Texas) in the Journal of Hospice and Palliative Nursing.

"Nurses need to place patient advocacy above fears of recrimination from physicians," they contend, after their findings showed that "authoritative boundaries" often prevent nurses from being able to "convince physicians of the need to alter pain medication regimens."

Ten female nurses who periodically cared for acutely and terminally ill patients took part in the questionnaire and interview-based study.

One of the most common barriers to effective pain management mentioned by respondents was knowledge, skills, and experience relating to pain assessment, with nurses commenting on their concerns about harming patients by "giving too much" pain relief.

Judging patients' reports about the degree of pain they are experiencing and conflicts between family members about how sedated they want their relative to be also emerged as barriers to effective pain management, report the authors.

Fear of addiction emerged as a reason for withholding pain medication, and Duke and Jablonski suggest that healthcare providers have a duty to address any myths and misperceptions generated by "the media and conservative interest groups."

"Healthcare consumers place much trust in their providers, and many process that information as 'gospel'," they say.

The nurses reported that education, individualized care, and use of specialty services (ie, hospice care) were the main routes to facilitating effective pain management.

Duke and Jablonski highlight the latter as a "major practice implication," indicating that "patients who are known to be terminally ill and/or in the last days of their life should not be cared for in an acute care setting," which the nurses describe as "too fast paced."

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