Disparities in End of Life Pain: A Pilot Study in Hospice

Abstract

Cancer is one of the leading causes of death. Pain is one of the most common, feared, and distressing symptoms associated with cancer. Minorities experience more severe pain than non-Hispanic whites and are more likely to have their pain inadequately assessed and treated. Disparities in pain associated with cancer at the end of life are not well understood. This study sought to investigate the trajectory of cancer pain in those in an inpatient hospice facility and investigated disparities in nursing pain scores. A retrospective chart review was conducted to collect the following data: demographics, cancer diagnoses, and nursing pain scores. Those with any type of cancer who died in the hospice facility were included. Descriptive statistics were used to describe the sample and high and low pain scores during the day shift. An independent t-test was used to examine disparities in nursing pain scores between whites and blacks. Results from the study suggest those with cancer experience pain at the end of life, even when receiving optimal pain control in an inpatient hospice setting. Pain scores on the first 10 days after admission to hospice ranged from 0 to 10 with 20% reporting severe pain (pain scores 8-10) on the day of admission. Significant differences in mean high pain scores were found between blacks and whites on days 3 (p= 0.010) and 5 (p= 0.032). Results suggest pain continues to be a problem at the end of life in those diagnosed with cancer. Nurses must educate patients and families about pain goals in hospice and note that it may not be possible to achieve a complete absence of pain in this population.