John Cagle, PhD, MSW General Assembly of the Social Work Hospice & Palliative Care Network

Transcription

1 John Cagle, PhD, MSW 2016 General Assembly of the Social Work Hospice & Palliative Care Network

2 The Issue % of pain can be treated HOWEVER -- seriously ill patients still suffer with inadequate pain management Patient/family concerns identified as the most significant barrier to pain management: Families unable to implement/maintain treatments Families do not want the treatments

3 Eight Major Concerns 8 patient/family concerns about pain and pain management in palliative care: 1. Addiction 2. Tolerance 3. Side effects 4. Stoicism 5. Stigma 6. Not wanting to be a bother 7. Overdose 8. Fatalism

4 Other Complicating Factors Gaps in Communication Challenges with Adherence Cultural issues

5 Minorities Regarding pain and pain management, African American and Hispanic individuals tend to report: More concerns Higher levels of concern

6 Our Role Major barriers to pain management in palliative care are psychosocial and thus within the wheelhouse of social work!

7 The EMPOWER Approach EMPOWER (Effective Management of Pain: Overcoming Worries to Enable Relief) program Educate the entire hospice team Assess concerns: Early (i.e., at admission) Cover all 8 barriers Both patient AND caregiver

8 The EMPOWER Approach (cont.) Tailored Education EMPOWER Brochure Address concerns identified during assessment Discuss adherence Follow-up Add to care plan Revisit as needed

9 Changing Behavior When introducing a new medication regimen, we are asking patients/families to alter their behavior and behavioral change is very difficult EMPOWER included tips for improving adherence

10 Facilitating Adherence Identify responsible person(s) Determine need for reminders Evaluate knowledge/education level Assess current adherence Provide information (e.g., basic pain assessment, dosing)

11 Is EMPOWER Effective? We tested EMPOWER with a small, randomized trial of hospice users: 55 in the intervention group 71 in the control group

12 EMPOWER Outcomes Participants in the intervention group had: Better knowledge (p<.001) Fewer concerns (p=.001) Lower levels of patient pain (p=.001) EMPOWER appeared especially beneficial for African American families at: Reducing stigma Increasing self-efficacy

13 Caregiver Concerns at 2 Weeks Level of concern for 8 barriers to pain management *p<0.05; **p<0.001 ; ***p<. ; Note: Ratings ranged from = Not concerned at all to = Very concerned. Means are unadjusted. Sample size at 2 weeks post-admission: Intervention N=55; Control N=71.

14 Caregiver Concerns at 3 Months Level of concern for 8 barriers to pain management *p<0.05; **p<0.001 ; ***p<. ; Note: Ratings ranged from = Not concerned at all to = Very concerned. Means are unadjusted. Sample size at 3 months post-admission: Intervention N=18; Control N=26.

15 Patient pain Patient s pain level over the past week P <. 5; Subjects response to the question: Over the past week, how much pain do you feel [the patient] had? =No pain; 10=A great deal of pain. Sample size at 2 weeks post-admission: Intervention N=55; Control N=71. Sample size at 3 months post intervention: Intervention N=18; Control N=26.

16 Take Home Messages. Pain treatments are useless if people don t feel comfortable enough to give/take them 2. Concerns about pain medications are a major impediment to pain management 3. EMPOWER is a promising, evidence supported approach to addressing common barriers to pain management 4. Rely on the strengths of your interdisciplinary team

17 Acknowledgements Agency for Healthcare Research and Quality (AHRQ), 1-R03-HS Cagle, J. G., Zimmerman, S., Cohen, L., Porter, L., Hanson, L. & Reed, D. (2015). EMPOWER: An intervention to address barriers to pain management in hospice. Journal of Pain and Symptom Management, 49, doi: /j.jpainsymman Cagle, J. G. (2016). The management of patient pain as a potential source of family conflict in hospice. In K. J. Doka, & A. S. Tucci (Eds.) Managing Conflict, Finding Meaning Supporting Families at Life s End. Washington DC: Hospice Foundation of America. Hong, S., Cagle, J. G., Van Dussen, D. J., Carrion, I. V., & Culler, K. L. (in press). Willingness to use pain medicine to treat pain. Pain Medicine. doi: /pme Carrion, I. V., Cagle, J. G., Van Dussen, D. J., Culler, K. L., & Hong, S. (2015). Knowledge about hospice care and beliefs about pain management: Exploring differences between Hispanics and non-hispanics. American Journal of Hospice and Palliative Medicine, 32, doi: / Cagle J. G., & Altilio, T. (2011). The social work role in pain and symptom management. In T. Altilio & S. OtisGreen (Eds.), Oxford textbook of palliative social work. New York: Oxford University Press. Bergman-Evans, B. (2006). AIDES to improving medication adherence in older adults. Geriatric Nursing, 27, And especially all of the patients, families and providers who participated in this research!

18 Thank you!!!