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Experts applaud new measures
The Oakbrook Terrace, IL-based Joint Commission on Accreditation of Health Care Organizations (JCAHO), which accredits most of the nation’s hospitals and thousands of other health care organizations, has begun monitoring how well these facilities assess and treat pain, marking another positive step toward recognition of the need for better pain management.
The new pain management standards are included in the 2000-2001 Joint Commission standards manuals, and JCAHO surveyors have begun assessing compliance since they took effect Jan. 1. JCAHO’s new pain management standards were welcomed by clinicians, pain experts, patients, and their families who have seen pain go untreated or undertreated for decades.
"These changes have the power to improve the quality of life for millions and millions of Americans," said June L. Dahl, PhD, professor of pharmacology at the University of Wisconsin Medical School and president of the American Alliance of Cancer Pain Initiatives (AACPI). "This is a great victory for cancer patients in particular, whose pain is often undertreated. Many caregivers, particularly those involved in cancer treatment, have been challenging health care leaders for years about the need to assess and treat patients’ pain better."
Under the new JCAHO standards, patients should be asked about pain and the intensity of the pain, including rating it on a simple zero-to-10 scale. Doctors and nurses will be expected to treat the patient’s pain and continue to assess treatment during and after hospitalization.
Studies show that an estimated 70% of people with cancer experience significant pain, while fewer than half receive adequate pain treatment. Fifty million Americans suffer from chronic pain, and four out 10 people with moderate to severe chronic pain do not receive adequate relief.
"The standards acknowledge that pain is a condition that needs explicit attention," said Carole Patterson, MN, RN, director of the Standards Interpretation Unit of JCAHO. "Research shows that surgical pain and pain at the end of life, such as cancer pain, has not been managed well. Therefore, these standards should have
a significant impact on pain management for patients."
The AACPI and the nearly 50 State Cancer Pain Initiatives headed by nurses, physicians, pharmacists, social workers, and researchers have long been advocates for better pain control in the nation’s health care system. These organizations say the new standards are a milestone
in efforts to overcome barriers to effective pain relief.
Today’s move will not affect all hospitals, nursing homes and other facilities — only those accredited by the JCAHO. The JCAHO accredits 80% of the nation’s hospitals, accounting for 98% of the nation’s hospital beds.
"Undertreating pain has been and still is bad medicine, and is often based on unfounded fear, ignorance, or miscommunication by health care professionals and patients," Dahl said. "Hopefully, the new standards will begin to change this."
Physicians can involve additional people in the care of terminally ill patients to ensure that their quality of life doesn’t deteriorate in their final days, according to a study by Mayo Clinic researchers.
The study authors note that physicians as a group may prolong end-of-life suffering with aggressive approaches to "cure" the patients’ underlying disease rather than acknowledging that the time has come to provide the patient with palliative care services.
However, strategies can be taken to reduce the suffering of a patient by orchestrating a multidimensional approach to helping ensure the quality of life at the end.
The special article, done for the Mayo Clinic Cancer Center Quality of Life Working Group, appears in Mayo Clinic Proceedings.
Before the 1900s, most Americans died at home surrounded by their loved ones. Currently, as many as 60% will die in hospitals, and up to an additional 25% will die in health care-related facilities such as nursing homes. Physicians have had an ever-expanding role in the manner in which people die, with so many Americans dying in hospitals and other health care facilities.
"With modern medicine emphasizing genetic manipulations, high technology, and cure at all costs, we often neglect what was once the most sacred aspect of being a physician: alleviating suffering," the authors write. "Therefore, we contend that the approach to a person dying in the hospital must change from simply postponing death to focusing medical interventions on maintaining quality of life to the end."
The authors defined the term "quality of life" as the physical, psychological, social, and spiritual domains of health that are influenced by a person’s experiences, beliefs, expectations, and perceptions.
The Mayo Clinic authors conclude their article: "We believe that the principles that have been
so successful in improving the quality of life for hospice patients must be adopted in hospitals and related facilities such as nursing homes so that suffering can be relieved where the vast majority of Americans continue to die."
Source: Rummans TA, et al. Maintaining quality of life at the end of life. Mayo Clinic Proc 2000; 75:1305-1310.
The federal Administration on Aging released $125 million to states in January for programs supporting caregivers of elderly or disabled family members.
The federal money is set aside for programs supporting caregivers of older adults who have dementia or are significantly disabled. Relatives or guardians 60 or older who care for a disabled child also will benefit, recognizing, for example, the needs of older adults caring for adult children who are mentally disabled.
Among the states receiving funds are Oregon and Washington. Oregon will receive $1.4 million and Washington will receive $2.1 million as part of the National Family Caregiver Support Program under the newly reauthorized Older Americans Act.
"With the aging of our community, there aren’t going to be enough family resources to take care of the elders and the children in a family," said Mary Lou Ritter, chairwoman of the Oregon Association of Area Agencies on Aging and Disability. "The funding is just the beginning of recognizing the impact on families of caring for a family member."
The money will go to the aging services agencies in each state. Clackamas County Social Services, for example, plans to spend its estimated $132,000 on expanding respite services, giving more people a temporary break from caregiving duties, said John Mullin, agency director.
Washington County’s estimated $100,000 will go to caregiver support groups, counseling, training, and connecting caregivers with social services.
"This is welcome funding for us to really be able to get in and do some good things for families," said Ritter, who is also director of the Washington County Department of Aging and Veterans Services.