Effective Cancer Pain Management in the Home Hospice Setting

Effective Cancer Pain Management in the Home Hospice Setting

PICO Question Identified In The Paper

The aim of the paper is to critically analyse the paper: Johnson, L. A., Bell, C. J., Ridner, S., & Murphy, B. (2021). Health-Care Professionals Perceived Barriers to Effective Cancer Pain Management in the Home Hospice Setting: Is Dying at Home Really Best?. OMEGA-Journal of Death and Dying, 83(3), 587-600. https://dx.doi.org/10.1177/0030222819857871. Pain management is essential as it improves the quality of life of the individual. The pain if lingers in a person decreases the body’s ability to conduct several works and leads to ultimately decrease in the individual ability to stay fit. In cancer, the pain is caused due to the destruction of tissue in the body (Bennett et al., 2019)Effective Cancer Pain Management in the Home Hospice Setting. As the tumour advances, it presses the nearby nerves, organs and even the bones and as well releases chemicals that ultimately cause pain in the individual.

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There are a number of procedures to treat cancer patients. The first procedure is to use pain relievers and medication such as aspirin and ibuprofen (Lundberg & Howatson, 2018). This is for mild to moderate cancer pain. Opioids can also be used as a medication for moderate to severe pain. This medication is for short time pain relief and needs to be taken often however all the medication need to be taken after consulting with the physicians. The second procedure is therapy and surgical procedures such as relaxation therapies, acupunctures or nerve block procedures (Wang et al., 2021). The PICO question identified in the paper is Patients (P): In the cancer patients, Intervention (I): the Hospice HCP face more barrier in the patient’s treatment, Comparison (C): than in a hospital setting, Outcome (O): for the pain management. In the paper, the topic that will be critically analysed is that the healthcare professionals providing pain management intervention at the patient’s home face several barriers. Effective Cancer Pain Management in the Home Hospice Setting

The search strategy is one essential Aspect Of Critical Analysis because it enables the researchers to support the prospective research by replicating the same methodology of the research. In a similar context, peer-reviewed journal articles were used which were retrieved from MEDLINE. To get the research articles, the pico question was used as the keyword and was searched by using Boolean operators AND or OR. The Boolean operators narrow down the paper to the Pico question. The AND Boolean operator is implied for narrowing the search result and OR Boolean operator is implied to broaden the search result. In MEDLINE, MeSH terms were implied. The MeSH word is used to find reliable information about a given issue. The term that was considered for the research are following [“In the cancer patients” or “cancer patients” ] in conjunction with [“Hospice HCP” and “home-based healthcare professionals”] in conjunction with [“pain management” or “management of pain among the patients”]. For achieving a credible result, the MEDLINE was used to inquire about data in easily and effectively. Effective Cancer Pain Management in the Home Hospice Setting

Methodology

The keywords used for the search are presented using in a tabular format:

The Inclusion and exclusion criteria for the research:

After reviewing the content of papers and removing the duplicates only 1 article is selected for the analysis. This paper is selected because the authors Johnson et al., (2021) have written the paper in a comprehensive manner and explained the significance of the topic using quantitative analysis that is patient population is included in the study.

The articles were reviewed according to the PRISMA flow chart of the results described below:

Figure:1

Search History Of Medline:

In the articles the authors Johnson et al., (2021) divided the participants into two focus groups with a total of twenty hospice employees in each group. The authors Johnson et al., (2021) observed that the females (75%) and Whites made up the majority of the group (80 per cent). The average age of the participants was 50.7 years. The average of 16 years of education, the respondents were well-educated. The majority of the participants had a lot of experience dealing (78 per cent said they had more than 5 years of experience) and 88 per cent said they had treated more than 10 patients suffering from pain in the last few months. In terms of pain control, three types of barriers emerged: (a) family caregiver barriers, (b) patient barriers, and (c) shared barriers. Each category has its own set of themes. Each concept is illustrated through exemplary quotations. The focus group (G) and speaker (S) numbers are used to identify participants. Numerous caregiver hurdles were highlighted by group members as impeding optimal pain medication for cancer patients undergoing home long term care. The anxiety of triggering the death, views about symptom management and required suffering, misconstruing pain signals, many conflicting viewpoints, disruption of family caretaker pharmaceutical expertise, and caregiver health limits were highlighted by Health professionals as the most important family caregiver hurdles. Family members, according to HCPs, were unsure and worried that pain drugs would expedite mortality. In the group, the authors Johnson et al., (2021) noticed that the main barrier the nurses faced is the difficulty to carry out a single procedure wherein the hospital setting other physicians and the nurses are present to help the nursing professional with trivial activities.

According to Wang et al., (2018) themes found by HCP in this research emphasize the significance of carefully analysing patients’ and their health providers’ attitudes and views in addressing pain and other symptoms in the healthcare setting at the terminal phase (Lovelace et al., 2019). Many factors determine how cancer pain is managed, including that of the squamous cell carcinoma, the source and degree of pain, and the physician’s and family caregiver’s attitudes and beliefs. At the time of death, individuals who die from cancer rely on family carers to manage their suffering. In a home care environment at the terminal phase, careful analysis will determine patient and staff educational needs about pain control, as well as psychological and spiritual considerations about pain, as suffering often worsens as death approaches (Hitomi Irizawa, 2019)Effective Cancer Pain Management in the Home Hospice Setting.

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Result

Challenges to cancer pain treatment reported by professional careers in this assignment, including such health providers’ concern of expediting death and gaps in knowledge causing difficulty appraising and sticking to analgesia prescriptions, have been confirmed in earlier investigations (Bahri, 2020). Patients had trouble articulating their pain and keeping track of how often they took drugs. According to the authors Røen et al., (2018) caregivers may overlook indications that are easily spotted by healthcare practitioners. Pain, for instance, might cause behaviour change like impatience, frustration, or a negative attitude. These indicators of increased discomfort may go unnoticed by family caregivers. Similarly, several patients would reduce their regular activities and as well limit their movement in order to avoid aggravating or exacerbating discomfort. Others may attempt to snooze more in order to avoid the persistent ache. Families might have to be informed about changes in mood or behavior that may indicate greater pain (Palermo et al., 2018). It been noted that several caregivers have next to no knowledge of or experience with pain management or drug administration. Furthermore, family caregivers and sufferers may still not always share the same perspectives on pain management’s major aims and consequences. Some individuals, for instance, can choose whether to accept a higher amount of pain in order to be less anesthetized. To ensure that the patient’s goals are satisfied, the patients and family members caregiver should establish the major goals of pain control (Abuatiq et al., 2020).

Patients and families and carers were unwilling to take drugs at occasions, according to the authors Johnson et al., (2021) of the study HCPs, due to various negative consequences such as disorientation or incontinence. Starting with the first hospice visit, hospice personnel, particularly nurses, must begin educating the patient and the family members about the management of pain. Accordig to the Diaz-Caneja et al., (2021) reliability and validity measures like the Pain Experience Scale and the Caregivers Pain Medication Questionnaires have shown promise in evaluating common knowledge gaps or concerns and the difficulties reporting pain or delivering pain medicine (Marín et al., 2021). Patients may require a personalized pain plan that includes scheduled doses of opioid analgesics in addition to pharmacologic and nonpharmacologic pain-relieving modalities such as music or individual counselling, physiotherapy, warm or cool compresses, or aromatherapy.

According to the Johnson et al., (2021) pain journal or diary as quality of practice after the admission of the patients in the home hospice could help the family members better in better document pain, pain management measures, and pain relief (Chi et al., 2020). A pain diary or record would reveal real evidence of suffering the individual felt and what are the tailored pain management tactics used on the individual. Family members sometimes had diverse viewpoints regarding how to diagnose and treat pain, according to one study, which created a barrier to successful pain management. Suffering was a hindrance in this research that warranted additional investigation. In-home pain assessments should include a consideration of religious and cultural ideas about suffering (van Wijngaarden, 2021). Considering religious and cultural views, as well as end-of-life wishes, is essential for determining religious needs and existentialist concerns. Professional caregivers may find it difficult to support patients’ attitudes about having to suffer in the treatment of cancer patient’s pain. Joining the armed forces community members who can start educating specialist caregivers, as well as assist patients and family members with religious and strong cultural beliefs concerning unbearable pain the individual have gone through, throughout their life, could be crucial in assisting teams in developing interventions to address patients’ transcendental hardship and religious aspects so that people with cancer can be efficaciously endorsed in hospice care settings. This study by Johnson et al., (2021) highlights the importance of collaborating with community partners to investigate ways to inform interventions by giving an additional layer of support, such as strategies to change perceptions that may obstruct support throughout the cancer journey until the end (Foley et al., 2021). In addition to religious and cultural ideas about suffering, this research reveals family beliefs about suffering, which are in direct conflict with hospice care’s core principles. Regardless of past misdeeds, no individual deserves to die in pain and suffering. In the home care context, hospice HCPs are on the front lines, able to detect patients who are at risk of suffering and provide end of life care to them. The patient’s plan of treatment must include proper documenting of pain and suffering, as well as vocal contact with the entire team Effective Cancer Pain Management in the Home Hospice Setting.

Discussion

In order to create interventions which can alleviate the pain and suffering of the patients living in the hospice can necessities an interdisciplinary approach. Home hospices or HCPs have several ethical accountabilities, such as when a family refuses to give recommended medication when it is needed; nevertheless, determining when and to what extent such intervention is warranted can be difficult. The first step is to figure out why a caregiver isn’t managing pain properly (Johnson et al., 2021). Hospice professionals should first design suitable educational approaches for the family caregivers including the family members who are sometimes misinformed or scared, with the goal of averting negative consequences. In the most serious circumstances, where caregiver management threatens life or causes undue suffering, hospice personnel may consider contacting adult child protection services. In some circumstances, the involvement of experts in the field may be required to help define when assistance is necessary. When a painless death is not possible at home, hospice providers should examine other options (Vanderveken et al., 2019). In this paper, the authors Johnson et al., (2021) have taken into account the cultural and ethical beliefs for implementing the hospice care which may authors have ignored in their study.

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The Johnson et al., (2021) explained that the family giver identified using the focus group interview identified that the having multiple caregivers for the care of the patients provide better outcome to the patients as because the having several people for the care the patients help to improve the quality of care provided to the patients. According to the Enguidanos & Rahman, (2022) the hospice care is increasing day by day however there are significant boundaries in the hospice care. This is highlighted by may authors as well for understanding the barriers I the care there are also several studies are conducted. The limitations identified by the authors for providing hospice care are discussed as follows: 1. Not properly implementing the patient’s recruitment strategies, 2. The timing of the stakeholder engagement and 3. The education provided to the healthcare assistants and the nursing assistants in order to provide hospice care is also not enough. The authors concluded that the palliative care and ethical policies also need to be implemented at the hospice which many nursing assistants ignore while providing the care. The hospice care improves the patient’s condition however also have boundaries with the implementation of proper education ad criteria can improve the hospice care provided to the patients.  Effective Cancer Pain Management in the Home Hospice Setting