Diffusion effects of an inpatient hospice unit on improving the parent hospital's pain management of terminally ill cancer patients not receiving hospice care in Taiwan.

BACKGROUND: The impact of hospice care on cancer-pain management at the institutional level of an acute-care hospital setting has not been addressed in prior research.

OBJECTIVE: The aim of the study was to investigate the diffusion effects of an inpatient hospice unit on improving the parent hospital's quality of pain management.

METHODS: A convenience sample of 1370 terminally ill cancer patients not receiving hospice care in Taiwan measured pain relief experiences and perceived pain-management practices of healthcare professionals.

RESULTS: Taiwanese terminally ill cancer patients in the with-hospice group were 2.40 times (95% confidence interval [CI], 1.53-3.76]) more likely than those in the without-hospice group to report their pain as not controlled before hospital admission. However, after patients with uncontrolled pain were hospitalized, they were equally as likely as those in the without-hospice group to report pain as not yet been relieved when interviewed (adjusted odds ratio, 1.42; 95% CI, 0.77-2.64). Patients in the with-hospice group were (1) less likely to complain about waiting too long for pain medication (adjusted odds ratio, 0.41; 95% CI, 0.18-0.93) and (2) more or as likely to rate the amount of pain medication received as adequate (depending on the status of adequate pain control before admission) than/as those from hospitals without an inpatient hospice unit.

CONCLUSION: Hospice care may add value at the institutional level by effectively and appropriately managing cancer pain of Taiwanese terminally ill patients not receiving hospice care.

IMPLICATIONS FOR PRACTICE: Translation of evidence-based strategies to manage cancer pain could be facilitated by expanding collaboration between hospice-care professionals and other healthcare professionals both within and among institutions.