The Effect of a Translating Research into Practice (TRIP)‐Cancer Intervention on Cancer Pain Management in Older Adults in Hospice

Background.  Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain‐free death, and while outcomes are better in hospice, patients still die with poorly controlled pain. Objective.  This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence‐based pain practices for older adults with cancer in community‐based hospices. Setting.  This Institutional Human Subjects Review Board‐approved study was a cluster randomized controlled trial implemented in 16 Midwestern hospices. Methods.  Retrospective medical records from newly admitted patients were used to determine the intervention effect. Additionally, survey and focus group data gathered from hospice staff at the completion of the intervention phase were analyzed. Results.  Improvement on the Cancer Pain Practice Index, an overall composite outcome measure of evidence‐based practices for the experimental sites, was not significantly greater than control sites. Decrease in patient pain severity from baseline to post‐intervention in the experimental group was greater; however, the result was not statistically significant ( P  = 0.1032). Conclusions.  Findings indicate a number of factors that may impact implementation of multicomponent interventions, including unique characteristics and culture of the setting, the level of involvement with the change processes, competing priorities and confounding factors, and complexity of the innovation (practice change). Our results suggest that future study is needed on specific factors to target when implementing a community‐based hospice intervention, including determining and measuring intervention fidelity prospectively.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93516/1/j.1526-4637.2012.01405.x.pd

The Relationships among Pain, Nonpain Symptoms, and Quality of Life Measures in Older Adults with Cancer Receiving Hospice Care

Objective.  Gathering firsthand or reported information about patients in the final stages of terminal cancer is difficult due to patient frailty, cognitive impairment, excessive fatigue, and severity of illness, as well as gatekeeping by hospice providers and caregivers, and highly variable documentation practices. We sought to further understand and elucidate end‐of‐life experiences in older cancer patients through the application of validated tools employed in the hospice setting. This article summarizes data collected about pain, non‐pain symptoms, and other aspects of quality of life (QOL) as reported by older hospice patients or by their caregivers during the 2 weeks of hospice care. Design.  Data was collected from an ongoing Institutional Human Subjects Review Board‐approved research project with 94 older adults with cancer or their caregivers receiving service in a home setting from 14 Midwestern hospices. Participants completed one or two telephone interviews. Instruments used to gather information include the Brief Pain Inventory and the Brief Hospice Inventory. Results.  Data analysis showed mean “worst pain” ratings significantly decreased from Interview 1 to Interview 2, and pain reports were significantly correlated with fatigue, anxiety, appetite, comfort, symptom control, and overall QOL. Conclusions.  Our findings reinforce previously held views that older patients with cancer experience pain and non‐pain symptoms. And both pain and non‐pain symptoms can impact and confound the treatment of other symptoms and interfere with the patient's overall QOL. The results of this study support the assertion that hospice care can have a positive impact on pain severity and related suffering, as well as patient QOL as death approaches.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87068/1/j.1526-4637.2011.01113.x.pd

Leveraging Patient/Community Partnerships to Disseminate Patient Centered Outcomes Research in Geriatrics

Background: With the growth of patient-centered outcomes research (PCOR), partnerships between researchers and patients have presented novel opportunities for disseminating results. A large gap exists in disseminating patient-centered research results to older adult patient end-users. We sought to examine the experiences of patient/community partners in disseminating PCOR results and characterize lessons learned that may facilitate future researcher-patient/community dissemination partnerships. Methods: Patient/community partners who participated in geriatrics-focused PCORI-funded research and were active in disseminating results, as part of their planned activities, were recruited for one-to-one qualitative interviews. Constant comparative and thematic analysis were used to identify and describe common themes that emerged in a survey of open-ended questions. Results: Ten individuals (four community partners, six patients) aged 55–87 years were interviewed. Analysis revealed that for successful dissemination, subjects felt it was vital to reach out to people affected by the results, leverage personal stories, and tap into pre-developed programming. Patient/Community partners identified potential audiences through word-of-mouth, community requests, and mapping a list of audiences—targeting those directly affected as well as those who worked with the audience (e.g., not specifically medical). Patient/community partners recommended that researchers engage patient/community partners for suggestions on audiences, show empathy, include diverse populations, and maintain a community-focus. One community partner stated, “Why wouldn’t we help disseminate results? It’s a no-brainer. We know people!” Conclusion: Patient/community partners provide effective ways to communicate results, new audiences to reach, improved communication with different audiences, and improved credibility of the findings. The lessons learned have implications for assisting future research-patient/community partnerships in the dissemination of their patient-centered research

Leveraging Patient/Community Partnerships to Disseminate Patient Centered Outcomes Research in Geriatrics

Background: With the growth of patient-centered outcomes research (PCOR), partnerships between researchers and patients have presented novel opportunities for disseminating results. A large gap exists in disseminating patient-centered research results to older adult patient end-users. We sought to examine the experiences of patient/community partners in disseminating PCOR results and characterize lessons learned that may facilitate future researcher-patient/community dissemination partnerships. Methods: Patient/community partners who participated in geriatrics-focused PCORI-funded research and were active in disseminating results, as part of their planned activities, were recruited for one-to-one qualitative interviews. Constant comparative and thematic analysis were used to identify and describe common themes that emerged in a survey of open-ended questions. Results: Ten individuals (four community partners, six patients) aged 55–87 years were interviewed. Analysis revealed that for successful dissemination, subjects felt it was vital to reach out to people affected by the results, leverage personal stories, and tap into pre-developed programming. Patient/Community partners identified potential audiences through word-of-mouth, community requests, and mapping a list of audiences—targeting those directly affected as well as those who worked with the audience (e.g., not specifically medical). Patient/community partners recommended that researchers engage patient/community partners for suggestions on audiences, show empathy, include diverse populations, and maintain a community-focus. One community partner stated, “Why wouldn’t we help disseminate results? It’s a no-brainer. We know people!” Conclusion: Patient/community partners provide effective ways to communicate results, new audiences to reach, improved communication with different audiences, and improved credibility of the findings. The lessons learned have implications for assisting future research-patient/community partnerships in the dissemination of their patient-centered research.</jats:p

Assessing and Treating Pain in Hospices: Current State of Evidence-Based Practices

The aim of this article is to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index (CPPI), a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of the those key evidence-based practices (EBPs) that were applicable to their situation. When examining individual practices, the majority of patients had their pain assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps including: additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the Pain Treatment Plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by pain medication increases (15.8%); monitoring of analgesic- induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both non-pharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices

Geriatric pain competencies and knowledge assessment for nurses in long term care settings

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings