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Unrestricted opiate administration for pain and suffering at the end of life: Knowledge and attitudes as barriers to care.

Fineberg, Iris Cohen and Brown-Saltzman, K. and Wenger, N. S. (2006) Unrestricted opiate administration for pain and suffering at the end of life: Knowledge and attitudes as barriers to care. Journal of Palliative Medicine, 9 (4). pp. 873-83. ISSN 1096-6218

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Abstract

Background: Pain and symptom management is critical for quality end-of-life care in the hospital. Although guidelines support the use of unrestricted opiate administration to treat refractory pain and suffering in the dying patient, many patients die suffering with symptoms that could have been addressed. Methods: A multidisciplinary convenience sample of 381 hospital-based health care providers completed a survey evaluating their understanding of the principles of treating refractory pain and suffering at the end of life in the hospital, knowledge of the institution’s policy about how to implement such care, and attitudes about and comfort with such treatment. Results: Respondents recognized pain and symptom management as a goal of unrestricted opiate use at the end of life, but 12% identified comfort for families or treatment of nonphysical suffering as the principal goal of this modality. Two thirds of respondents felt that unrestricted opiates were used too rarely and 45% felt they were used too late. However, 16% felt uncomfortable administering unrestricted opiates and 21% of physicians and nurses who had used restricted opiates reported having felt pressured to increase dosing of opiates. Knowledge deficits concerning appropriate candidates for unrestricted opiates and the protocol for appropriate implementation were common. Conclusions: Knowledge deficits and attitudinal concerns may hamper the administration of unrestricted opiates for refractory pain and suffering at the end of life in the hospital. Clinician education and clarification of the appropriate use of this modality when there are differences in clinician and family perception of discomfort are needed.

Item Type: Article
Journal or Publication Title: Journal of Palliative Medicine
Additional Information: RAE_import_type : Journal article RAE_uoa_type : Social Work and Social Policy & Administration
Subjects: R Medicine > RM Therapeutics. Pharmacology
Departments: Faculty of Health and Medicine > Health Research
ID Code: 3312
Deposited By: ep_importer
Deposited On: 20 Mar 2008 11:18
Refereed?: Yes
Published?: Published
Last Modified: 26 Jul 2012 17:22
Identification Number:
URI: http://eprints.lancs.ac.uk/id/eprint/3312

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