Inpatient palliative care and patient pain: pre- and post-outcomes

Hospitalized patients with serious illness often receive inadequate pain and symptom management at the end of life.

To test the effectiveness of an interdisciplinary inpatient palliative care (IPC) consultation program in the management of pain among seriously ill patients during hospitalization, and to examine IPC patient pain outcomes 10 days following hospital discharge.

A two-year pre-post study was conducted at a nonprofit health maintenance organization medical center in Los Angeles County. Hospital patients (n = 484) aged 65 years and older with life-threatening, complex, chronic conditions received comprehensive assessment, pain and symptom relief, care planning, counseling, and other supportive services from an IPC team. Measures included self-reported pain at baseline, two and 24 hours following IPC intervention, discharge, and 10 days post-discharge.

Mean pain was significantly different between baseline (1.56 ± 2.79) and two hours (0.91 ± 1.59; P < 0.001), 24 hours (0.77 ± 1.58; P < 0.001), and hospital discharge (0.40 ± 1.09; P < 0.001). Mean pain 10 days after discharge (2.04 ± 2.79; P < 0.001) was significantly higher than mean pain at discharge. Number of chronic conditions, probability of mortality, and discharge to hospice care significantly predicted increased pain following discharge.

To the authors' knowledge, this is the first study to follow IPC patient pain after hospital discharge. Findings support IPC teams' effectiveness in managing pain during hospitalization but suggest a lack of continuity in pain management following discharge. Research exploring IPC patient post-discharge transition experiences will likely improve understanding of post-discharge pain outcomes.