NURS 601 Assignment 1.1 PICO Question PDF

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Running Header: ASSIGNMENT 1.1: PICO QUESTION

ASSIGNMENT 1.1: PICO QUESTION Maryville University March 15, 2020

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Running Head: ASSIGNMENT 1.1: PICO QUESTION PICO Question Introduction Having worked as both a hospice nurse and a hospice director, the ability to maintain a patient’s quality of life during the end-of-life care has always been a challenging aspect of nursing. For this reason, I have chosen to research and examine whether or not hospice patient pain levels can be controlled with non-opioid therapies. Evidence Based Practice in Nursing PICO Question For this assignment, students have been tasked with identifying a PICO question as well as outlining the population, intervention, comparison, and outcome associated with the identified question. For this assignment, our question will focus on how hospice patients (P) receiving nonopioid pain medication (I) with a diagnosis of cancer or other chronic disease (C) compare to hospice patients who receive opioid medications(O) during end-of-life pain during the weeks or months leading up to the death (T). There were a total number of 393 studies identified and I have included at least six of those studies in this assignment. Keywords used included “end of life pain management in hospice.” The setting for this PICO question will be patients who are receiving hospice services related to a cancer diagnosis or other chronic disease diagnosis which increases the chance for unrelieved pain for the patient. Define the Population The population being studied are hospice patients dealing with end-of-life pain management and whether end-of-life pain is managed more effectively by opioid or non-opioid medication. Pain management at the end-of-life stage is a priority issue for hospice patients. This issue has been complicated by the current opioid crisis within the United States. Providers are being challenged to find more effective means of end-of-life pain management without the use of opioid prescriptions. Most healthcare providers will all agree with you that a consistent and

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Running Head: ASSIGNMENT 1.1: PICO QUESTION constant pain assessment is the only true way to determine whether or not a patient’s current therapy is successful in controlling pain. [ CITATION Lel05 \l 1033 ] Define the Intervention The intervention or issue being researched is how effective are non-opioid management techniques during end-of-life pain for hospice patients with a diagnosis of cancer or other chronic disease diagnosis versus end-of-life pain management with opioid medications. The problem of successfully managing end-of-life pain is extremely prevalent within the hospice sector. The current opioid crisis in the United States has created a unique challenge for providers to treat end-of-life pain while maintaining a minimum amount of opioid prescriptions. The majority of end-of-life patients receiving opioids to control pain will maintain their opioid schedule as prescribed with no major difficulties in regard to dose reduction and some will even discontinue their medications if their pain resolves. [ CITATION Bru18 \l 1033 ] Define the Comparison The comparison will be whether end-of-life pain in hospice patients with cancer or other chronic disease which cause uncontrolled pain can be managed with non-opioid medications, adjuvant analgesics or will require the use of opioids. Some of the less common adjunct techniques to alleviate pain include acupuncture, radiofrequency ablation of nerves and joints, neurolysis of nerves and nerve plexuses, radiofrequency ablation of dorsal root ganglion, regional analgesia, and spinal cordotomy. [ CITATION Mic10 \l 1033 ] Define the Outcome The specific outcome will be determined by whether hospice patients with end-of-life pain can achieve pain management without the use of opioids. To understand if an outcome has been successful, one must take into consideration that any for of opioid treatment will have

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Running Head: ASSIGNMENT 1.1: PICO QUESTION varying responses within a patient population based on various pharmacodynamic and pharmacokinetic interactions. [ CITATION Hra07 \l 1033 ] Define the Timeframe The timeframe for this outcome interest would be six weeks to one year. This timeframe was used to assess patients as they progressed through the end-of-life stage. Conclusion In conclusion, the problem of successfully managing end-of-life pain is extremely prevalent within the hospice sector. The current opioid crisis in the United States has created a unique challenge for providers to treat end-of-life pain while maintaining a minimum amount of opioid prescriptions. There are various factors that must be taken in to consideration to determine whether or not a non-opioid or an opioid medication regimen is most effective for each individual patient.

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Running Header: ASSIGNMENT 1.1: PICO QUESTION

References Boyd, M., Frey, R., Balmer, D., Robinson, J., McLeod, H., Foster, S., . . . Gott, M. (2019). End of life care for long-term care residents with dementia, chronic illness and cancer: prospective staff survey. BMC Geriatrics, 2-9. doi:https://doi.org/10.1186/s12877-019-1159-2 Bruera, MD, E., & Del Fabbro, MD, E. (2018). Pain Management in the Era of the Opioid Crisis. American Society of Clinical Oncology, 807-812. Enting, MD, R. H., Oldenmenger, R.N, W. H., van der Rijt, M.D, C. C., Wilms, M.Sc., E. B., Elfrink, R.N., E. J., Elswijk, R.N., I., & Sillevis Smitt, M.D., P. A. (2002). A Prospective Study Evaluating the Response of Patients with Unrelieved Cancer Pain to Parenteral Opioids. Cancer, 3049-3056. Hrachya Nersesyan, K. V. (2007, June 3). Current aproach to cancer pain management: Availability and implications of different treatment options. Theuraputics and Clinical Risk Management, 381400. Retrieved March 11, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386360/ Leleski, DO, J. P., & Lewandowski, MD, J. G. (2005). Pain Management in End-of-Life Care. The Journal of the American Osteopathic Association, 105, 6S-11S. Retrieved from https://jaoa.org/article.aspx? articleid=2093056 Michael Platt, M. (2010). Pain challenges at the end of life - pain and palliative care collaboration. Reviews in Pain, 18-23.

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