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Barriers to effective symptom management in hospice
Daniel C Johnson1, Cordt T Kassner, Janet Houser
1Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Journal of Pain and Symptom Management
|January 18, 2005
Summary
Hospice nurses identified family caregiver limitations, patient/family refusal of care, and multiple symptoms as key barriers to managing pain and dyspnea in terminally ill patients. Addressing these barriers is crucial for improving hospice symptom management.
Area of Science:
- Palliative Care
- Hospice Nursing
- Symptom Management
Background:
- Effective symptom management is critical in hospice care for terminally ill patients.
- Barriers to optimal symptom control in hospice settings are not fully understood.
- Understanding these barriers can inform interventions to improve patient quality of life.
Purpose of the Study:
- To identify and describe barriers to effective symptom management as perceived by hospice nurses.
- To explore variations in barriers across different common symptoms in terminally ill patients.
Main Methods:
- A survey was distributed to nurses affiliated with the Population-based Palliative Care Research Network (PoPCRN).
- Nurses from 67 hospices across 25 U.S. states participated, with a 51% response rate (867/1710).
- Nurses reported on the difficulty of managing 32 common symptoms and perceived barriers.
Main Results:
- Agitation, pain, and dyspnea were reported as the most difficult symptoms to manage (45%, 40%, 34% respectively).
- Primary barriers included family caregiver inability to implement treatments (38%), patient/family refusal of treatments (38%), and competing symptom distress (37%).
- Identified barriers differed depending on the specific symptom being managed.
Conclusions:
- Hospice nurses frequently encounter multiple barriers that impede effective symptom management.
- These barriers contribute to unrelieved symptom distress in patients receiving hospice care.
- Future interventions must consider the symptom-specific patterns of barriers to enhance hospice care.