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Pain-related distress among patients referred to a community-based palliative care program

Published online by Cambridge University Press:  26 June 2018

Alexa Riggs ,
Brenda Breuer ,
Vaishali Patel ,
Joshua Harounian ,
Jack Chen ,
Lara Dhingra ,
Russell K. Portenoy  and
Helena Knotkova
Alexa Riggs
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY
Brenda Breuer
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY
Vaishali Patel
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY
Joshua Harounian
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY
Jack Chen
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY
Lara Dhingra
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY
Russell K. Portenoy
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY Department of Neurology, Albert Einstein College of Medicine, The Bronx, NY MJHS Hospice and Palliative Care, New York, NY
Helena Knotkova*
Affiliation:
MJHS Institute for Innovation in Palliative Care, New York, NY Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY
*
Author for correspondence: Helena Knotkova, PhD, MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY, 10006 E-mail: [email protected]
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Abstract

Objective

Numerous studies have characterized the pain reported by patients with advanced illness in terms of descriptors such as severity, but few have measured pain-related distress. Distress may be important in the clinical approach to pain. To evaluate pain-related distress among adult patients with advanced illness and pain following enrollment in an urban, specialist-level, community-based palliative care program.

Method

In a retrospective cross-sectional analysis, data were extracted from the electronic health records of all patients who were able to complete the pain item from the Condensed Memorial Symptom Assessment Scale at the start of care. Bivariate and multivariate analyses evaluated the associations between distress and both sociodemographics and disease-related information.

Results

The 506 patients completing the pain item had a mean (SD) age of 70.7 years (13.8); 64.2% were women, 32.1% were Hispanic, 32.6% were white, and 27.7% were black. Of the 503 patients who indicated some level of distress on a 0–4 scale, 221 (43.7%) had high distress, defined as a score ≥3 (“quite a bit” or “very much”). Cancer diagnosis and poor performance status (unable to care for self) were predictors of high pain-related distress (both p < 0.05).

Significance of results

Among patients with advanced illness who reported pain at the start of care by a specialist palliative care program, high pain-related distress was common, particularly among those with cancer or poor physical function. Further studies are needed to explore the extent to which pain-related distress should inform the assessment and management of pain.

Keywords

Community-based palliative careCMSASpain-related distress
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 3 , June 2019 , pp. 338 - 344
Copyright
Copyright © Cambridge University Press 2018 

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