Hostname: page-component-76fb5796d-skm99 Total loading time: 0 Render date: 2024-04-25T17:53:07.904Z Has data issue: false hasContentIssue false
  • English
  • Français

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: HKnotkov@mjhs.org
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrews, SC (2001) Caregiver burden and symptom distress in people with cancer receiving hospice care. Oncology Nursing Forum 28, 1469–1474.Google Scholar
Blinderman, CD et al. (2009) Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease. Journal of Pain and Symptom Management 38, 115–123.10.1016/j.jpainsymman.2008.07.006Google Scholar
Blinderman, CD et al. (2008) Symptom distress and quality of life in patients with advanced congestive heart failure. Journal of Pain and Symptom Management 35, 594–603.10.1016/j.jpainsymman.2007.06.007Google Scholar
Chang, VT et al. (2004) Shorter symptom assessment instruments: The condensed Memorial Symptom Assessment Scale (CMSAS). Cancer Investigation 22, 526–536.Google Scholar
Dhingra, L et al. (2014) Symptom burden clusters in underserved Chinese American cancer patients. The Journal of Pain 15, S9.10.1016/j.jpain.2014.01.040Google Scholar
Dhingra, L et al. (2011) Pain in underserved community-dwelling Chinese American cancer patients: Demographic and medical correlates. The Oncologist 16, 523–533.10.1634/theoncologist.2010-0330Google Scholar
Kutner, JS et al. (2007) Time course and characteristics of symptom distress and quality of life at the end of life. Journal of Pain and Symptom Management 34, 227–236.10.1016/j.jpainsymman.2006.11.016Google Scholar
Portenoy, RK and Lesage, P (1999) Management of cancer pain. The Lancet 353, 1695–1700.10.1016/S0140-6736(99)01310-0Google Scholar
Riggs, A et al. (2017) Hospice enrollment after referral to community-based, specialist palliative care: Impact of telephonic outreach. Journal of Pain and Symptom Management 54, 219–225.10.1016/j.jpainsymman.2017.03.007Google Scholar
Schag, CC, Heinrich, RL, and Ganz, PA (1984) Karnofsky performance status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology 2, 187–193.Google Scholar
US Census Bureau (2012) 2012 American community survey 1-year estimates: United States. http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh¼t. (2012, accessed 11 February 2016).Google Scholar
Vallerand, A, Templin, T, and Hasenau, S (2016) The power over pain-coaching intervention decreases pain-related distress and improves functional status in African Americans with cancer pain. Journal of Pain 17(4), S101.10.1016/j.jpain.2016.01.314Google Scholar
Van den Beuken-van Everdingen, MHJ et al. (2007) Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology 18(9), 1437–1449.Google Scholar
Villanueva, C and Aggarwal, B (2013) The association between neighborhood socioeconomic status and clinical outcomes among patients 1 year after hospitalization for cardiovascular disease. Journal of Community Health 38, 690–697.Google Scholar
Vowles, KE et al. (2017) Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Journal of Consulting and Clinical Psychology 85, 87.Google Scholar