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

Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) Instruments

Objective. To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. Design. In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. Setting. Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. Participants. Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. Measures. Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants\u27 usual pain intensity, and Pittsburgh Agitation Scale. Results. Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. Conclusions. Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment