Assessing Pain within Psychosocial Assessments at Hospice Agencies: A National Sample

BACKGROUND

Pain management is a key component of hospice care (Tjia et al, 2015). However, pain is multidimensional and includes physical, psychological, social, emotional, and spiritual elements (Clark, 1999).  Due to these multidimensional aspects, hospice social workers have a unique perspective that makes them ideally suited to address pain – especially the psychological, social and emotional dimensions (Altilio et al., 2007).  There are no national data on whether hospice social workers are paying attention to issues related to patient pain.  Our study seeks to fill this this gap in the literature.  This research examined the extent to which pain assessment content is included in psychosocial assessments from a national sample of hospice agencies.

METHOD

Data were collected from a random sample of 248 hospice agencies nationwide from all 50 states. Data included agency characteristics such as agency size, profit status, type of agency and location.  Hospices were contacted and asked to provide a blank copy of their psychosocial assessment.  Psychosocial assessments from participating agencies were then analyzed for their content.  Descriptive statistics were used to summarize agency characteristics.  Chi-square tests were used to examine whether pain assessment content was included in the psychosocial assessment based on agency characteristics.

RESULTS

A total of 105 agencies provided psychosocial assessments for our review of pain assessment content (42% response rate). Only one agency characteristic, profit-status, was observed to be associated with whether pain assessment content was included on the psychosocial assessment.  Fewer for-profit hospices (40%) had pain assessment content on their psychosocial intake form compared to non-profit agencies (60%; p<.001).  Of the 105 participating agencies, 50 (47.6%) had content assessing patient’s current pain included in their psychosocial assessment form.  Of the agencies that included assessment content on current pain status, the following pain assessment types were being used: General presence of pain n=33 (66%), Severity of pain n=22 (44%), Numeric analogue scale n=24 (48%), the faces of pain scale 6 (4%), non-verbal signs n=9 (18%), and impact of pain n=4 (8%).

CONCLUSIONS and IMPLICATIONS

Less than half of the psychosocial assessments reviewed in our sample included content on patient’s current pain. More work should be done to ensure that patients are being adequately screened for pain by social workers.  When pain is identified, social workers can work to address the social, psychological, and emotional dimensions of pain. Non-pharmaceutical interventions (e.g., meditation, guided imagery) and behavioral interventions (e.g., help with medication adherence) are also useful social work approaches to facilitate pain relief.