The association of demographic and clinical characteristics with pain in persons who received hospice care in the United States.

摘要

Pain at the end of life and in persons who received hospice care has not yet been fully described. The purpose of these studies was to describe persons who received hospice care in the United States (US), and to estimate the association between pain and the clinical and demographic characteristics of a sample of persons who received hospice care in the US. Data for these retrospective cohort studies were derived from the excelleRx dataset, which includes information about hospice organizations and persons who received hospice care from February 1, 2000-December 12, 2004. Worst pain intensity during the previous 24 hours was assessed using a 0-10 numeric rating scale (NRS; 0 = none, 10 = worst). Regression models were constructed using a backwards elimination approach for persons with at least two pain intensity scores. During the study period, 347,555 (90.7%) discharged or deceased persons received hospice care by December 12 2004. Among these individuals, 55.2% were female, 87.4% were Caucasian, and mean age at discharge was 75.3 years. At least one pain score was available for 45% of study participants. Pain was assessed an average of 2.9 times per person. Overall, mean fast and last pain score intensity was mild, but severe pain (NRS 7-10) was reported at least once by 20.3% of persons. Among persons who reported severe pain, 7.4% were cared for in LTC hospices and 73.9% had a primary diagnosis of cancer. Within the subset of 52,758 discharged or deceased persons assessed in the regression analyses, 52% were female, 87.4% were Caucasian, mean age at discharge or death was 73.8 years, and 66.2% of persons had a primary diagnosis of cancer. Pain was assessed an average of 4.1 times per person (median 3, SD 3.0, range = 2-44). Clinical and demographic characteristics accounted for 0.3% to 48.3% of the variability in the regression models. These data contribute to the understanding of the epidemiology of pain in this population and to the quality of hospice care in the US.