PORTLAND, Ore. — A new study published today by researchers at Oregon Health Sciences University may help explain why family reports of pain increased in dying hospitalized patients in late 1997. The OHSU Center for Ethics in Health Care surveyed physicians and nurses about their opinions regarding the observed increase. Most respondents (79 percent) thought that more than one factor was at work in explaining this worrisome change. The complete results are printed in the December issue of the Journal of Palliative Medicine.
According to the research, the vast majority (96 percent), of physicians and nurses believe the jump in family reports of pain was due in part to increased family expectations for pain management. Respondents reported that other significant factors included decreased physician prescribing of pain medications (66 percent) and reduced nurse administration of pain medication (59 percent). In addition, those respondents who thought physicians were more conservative in prescribing pain medications suggested the two main reasons were fear of investigation by both the Board of Medical Examiners and the Drug Enforcement Administration.
"While this study does provide important information, it can only be considered one piece of an incomplete puzzle," said Susan Hickman, Ph.D., a senior research associate with the Center for Ethics in Health Care and lead author of the study. "We must continue to investigate the increase in family reports of pain and explore the reasons behind it. We also must make efforts to ensure that dying patients are receiving the pain medication they need."
The increase in reports of pain was identified in a prior study conducted by OHSU’s center for ethics. Families of hospitalized patients in Oregon reported a jump in moderate and severe pain levels for their dying loved ones in late 1997. In late 1996 and early 1997, 33 percent of families reported that their loved one had experienced moderate or severe pain in the last week of life. In late 1997 this rate increased to 57 percent. This increase occurred in dying hospitalized patients only, not in those dying at home or in long-term care facilities.
"However, this study did not attempt to determine the cause of the reports of increased pain," explained Virginia Tilden, Ph.D., R.N., dean of research in OHSU's School of Nursing and co-author of the study.
Physicians and nurses for the new opinion survey study were contacted by mail through licensing lists maintained by the Oregon Board of Medical Examiners and the Oregon State Board of Nursing. Questionnaires were sent to professionals across Oregon who are likely to deal with dying patients in a hospital setting. A total of 411 (57 percent) of physicians and nurses completed the confidential survey. The Robert Wood Johnson Foundation and The Nathan Cummings Foundation sponsored the study.
"While Oregon is considered a national leader in pain management, the information obtained in this study reveals that there is more work to be done," said Susan Tolle, M.D., director of OHSU’s Center for Ethics in Health Care and co-author of the study. "Our earlier findings indicated more pain in dying hospitalized patients. In this study we learned that less pain medication administration was a partial contributor. We need to work on understanding the reasons behind reduced physician prescribing and decreased nurse administration to assure quality care for all dying patients."
Two editorials accompany the article. The first is by the journal's editor-in-chief, David E. Weissman, M.D., who draws an analogy between the average physician's fear of the DEA and a childhood fear of the bogeyman. The second editorial by June Dahl, Ph.D., a professor at the University of Wisconsin Medical School, examines the historical and evolving role of boards of medical examiners, concerns about regulatory scrutiny and associated impact on physician prescribing practices.
Journal
Journal of Palliative Medicine