Factors Associated with Challenging Pain Management in Terminally Ill Patients Within 48 Hours of Palliative Care Consultation
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Abstract
Background: Pain is one of the most common distresses for palliative care patients. Prolonged pain is increasingly difficult to manage. For this reason, early symptom management within the first 48 hours is of utmost importance and is the focus of the palliative care team. However, despite our best attempts, some patients do not respond to initial management. This study aimed to identify the factors associated with challenging pain management in palliative patients during their initial palliative care consultation.
Design: A retrospective cohort study
Methods: Palliative care patients with moderate to severe pain were recruited for the study. Patients who could not report pain scores by themselves were excluded. Patients’ characteristics, pain management, and pain score were reviewed in the first 48 hours of palliative care consultation. The factors associated with challenging pain management were analyzed using logistic regression.
Results: Of 997 palliative patients, 11.03% experienced difficult pain control. Difficult pain control was associated with age, dysphagia, severe symptoms of nausea, depression, anxiety, drowsiness, worse appetite, and worse well-being. Age, dysphagia, and severe depression were significantly related factors (OR 0.98, 95% CI 0.97-0.99, p-value 0.007, OR 1.83, 95% CI 1.03-3.27, p = 0.040, and OR 1.73, 95% CI 1.04-2.89, p = 0.035, respectively).
Conclusion: Age, dysphagia, and severe depression were the main factors for challenging pain management in palliative patients on initial palliative care consultation. Appropriate management of depression should be done to improve the outcomes.
Keywords: factor, difficult pain, palliative, terminally ill patient
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