Transitions of care and changes in distressing pain

Abstract

8078 Background: With the implementation of prospective payment for hospitals, dying cancer patients and families are faced with one or more care transitions in the last month of life. Methods: We conducted a 22 state mortality follow back survey to examine bereaved family members' perception of the level of distressing pain at the last two sites of care. Of the 1578 interviewed, 423 (48% female, 9% African-American, avg. age 72) of their family members had cancer listed as the leading cause of death on the death certificate. These 423 cases represent 550,732 persons who died from cancer based on national weights for the year 2000. Results: More than one half of the respondents (N-216) reported that the decedent was at more than one site of care in the last month. Thirty nine percent of decedents without a transition had distressing pain (% that report that pain bothered their loved one “quite a bit” or “very much”) The table below reports the percentage of individuals who experienced distressing pain and the percentage of persons with distressing pain at the second to last place who improved with care transition. Conclusion: Distressing pain is common regardless of the setting of care. With transitions, the majority of persons did not have an improvement in level of distressing pain as reported by bereaved family members. Increased attention is needed not only on how to adequately manage pain and pain-related distress, but also how to improve pain reduction measures between health care settings in the end-of-life. No significant financial relationships to disclose.