FOR IMMEDIATE RELEASE: 5 JUNE 2000
Contact: Jim Newman
[EMAIL PROTECTED]
503-494-8231
Oregon Health Sciences University
OHSU study reveals continued reports of increased pain in
dying hospitalized patients
Portland, Ore. -- A new study by researchers at Oregon Health Sciences
University notes continued reports of increased pain for dying, hospitalized
Oregonians in late 1998. The study, which is printed in this month's edition
of the Western Journal of Medicine, shows 54 percent of family members
reported their loved one had moderate or severe pain in the last week of life.
Previously gathered data shows a sharp increase in pain levels for dying
hospitalized patients. Complaints of high pain levels increased from 33
percent to 57 percent in late 1997. Susan Tolle, M.D., director of OHSU's
Center for Ethics in Health Care; Virginia Tilden, Ph.D., R.N., dean of
research in OHSU's School of Nursing; Susan Hickman, Ph.D., project director
at the Center for Ethics; and Anne Rosenfeld, Ph.D., assistant professor in
the School of Nursing, conducted both studies.
When combined, the studies identify a continued, sharp increase in family
reports of pain at the end of life for hospitalized patients. However,
researchers point out that neither study draws conclusions about cause and
effect. "We will never know why family members of hospitalized dying patients
reported higher rates of pain in late 1997, nor why they continued to report
higher rates of pain in late 1998," said Tilden, a co-author of the study.
"Late 1997 was a volatile time in Oregon's political and regulatory climate.
Events such as the legalization of physician-assisted suicide and an extensive
pre-ballot media campaign about end-of-life care were just a couple of the
things that were happening at the time."
Team members suggest possible explanations for increased reports of pain
include more family awareness about pain treatment options and a possible
change in physician prescribing practices due to fears of regulatory
sanctions. "On the one hand, families may have higher expectations about pain
management than they have in the past and may be reporting pain more
frequently," said Tolle, lead author of the study. "On the other hand, if
families are right that their loved ones did experience more pain, this raises
grave concerns. Were doctors writing less pain medication for these patients,
and if so, why?"
Both studies used similar methods to reach participating family members
through a random sampling of Oregon death certificates. Respondents were
contacted two to four months after the death of their loved one. If they
agreed to participate, they were interviewed by telephone. A total of 475
family members consented to take part in the initial study and 103 in the
follow-up study. "One challenge we faced in gathering this data was that
Oregon death certificates do not list contact information," said Hickman. "In
order to find family members, we had to search publicly available records,
such as obituaries. We were able to locate 51 percent of potential
respondents, and just over half of these family members agreed to
participate." The telephone interview included questions about advance
planning, pain management and communication issues. Only the question about
pain yielded changes over time, and this change was in hospitalized dying
patients only. The three main causes of death in hospitalized patients were
cancer, heart disease and cerebrovascular disease.
OHSU's Center for Ethics in Health Care has been tracking end-of-life care
markers for more than a decade. Until this study, the research suggested that
end-of-life care was improving in all areas. The markers of improvement
include: increased attention to advance planning, increased rates of hospice
referrals, increased physician and public education about end-of-life care
issues, decreased rates of in-hospital deaths, and decreased barriers to
prescribing narcotics.
The results of this study raise many questions, and the research team
stresses the need for more information. "Our study raises concerns about why
more families are reporting moderate and severe pain in dying hospitalized
patients," said Tolle. "Clearly, there is a pressing need for more research
into this troubling finding."
###
The Greenwall Foundation of New York, the Meyer Memorial Trust of Oregon
and the Open Society Institute Project on Death in America of New York
provided funding for this research.
Back to EurekAlert!
e_rel_header.gif