Sage Journals: Discover world-class research

Abstract

Background:

Opioid misuse and substance use disorders (SUDs) including opioid use disorder (OUD) are common and negatively impact quality of life. Hospice clinicians' experiences with these conditions have not been well described.

Objectives:

We sought to explore hospice clinicians' knowledge, practices, and comfort caring for patients with opioid misuse (e.g., a pattern of unsanctioned opioid use escalation, or concurrent illicit substance use) and SUDs.

Design:

We recruited hospice clinicians in the United States via national hospice and palliative care organizations to complete an online survey designed by the study authors and pilot tested with an interdisciplinary group of current/former hospice clinicians.

Results:

One hundred seventy-five clinicians (40% nurses, 40% physicians, 16% nurse practitioners) responded to the survey; most had cared for two or more hospice patients with opioid misuse or SUD in the past month. The majority felt confident identifying opioid misuse (94%) and taking SUD histories (79%). Most (62%) felt it is their role to treat hospice patients for SUD, though 56% lacked comfort in using buprenorphine for OUD treatment. While the majority felt it is their role to treat pain in hospice patients with SUDs (94%) and that hospice can help patients with SUDs (94%), many were not comfortable managing pain in patients taking buprenorphine (45%) or naltrexone (49%) for SUDs. Most felt comfortable managing pain in patients taking methadone for SUD (73%).

Conclusions:

Opioid misuse and SUD are common in hospice. Though clinicians are comfortable taking relevant histories, they feel less comfortable managing patients' opioid misuse or SUD, or these patients' pain.

Get full access to this article

View all access options for this article.

References

Sager

, Buss

, Hill

, et al. Managing opioid use disorder in the setting of a terminal disease: Opportunities and challenges. J Palliat Med, 2020; 23(2):296–299; doi: 10.1089/jpm.2019.0101

Bruera

, Moyano

, Seifert

, et al. The frequency of alcoholism among patients with pain due to terminal cancer. J Pain Symptom Manage, 1995; 10(8):599–603; doi: 10.1016/0885-3924(95)00084-4

Schenker

, Merlin

, Quill

. Use of palliative care earlier in the disease course in the context of the opioid epidemic: Educational, research, and policy issues. JAMA, 2018; 320(9):871–872; doi: 10.1001/jama.2018.9739

Gabbard

, Jordan

, Mitchell

, et al. Dying on hospice in the midst of an opioid crisis: What should we do now?. Am J Hosp Palliat Care, 2019; 36(4):273–281; doi: 10.1177/1049909118806664

Schulte

, Hser

. Substance use and associated health conditions throughout the lifespan. Public Health Rev, 2014; 35(2); doi: 10.1007/bf03391702

Manhapra

, Becker

. Pain and addiction: An integrative therapeutic approach. Med Clin North Am, 2018; 102(4):745–763; doi: 10.1016/j.mcna.2018.02.013

McLellan

, Lewis

, O'Brien

, et al. Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 2000; 284(13):1689–1695; doi: 10.1001/jama.284.13.1689

Passik

, Theobald

. Managing addiction in advanced cancer patients: Why bother?. J Pain Symptom Manage, 2000; 19(3):229–234; doi: 10.1016/s0885-3924(00)00109-3

Dowell

, Haegerich

, Chou

. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA, 2016; 315(15):1624–1645; doi: 10.1001/jama.2016.1464

10.

Manchikanti

, Kaye

, Knezevic

, et al. Responsible, safe, and effective prescription of opioids for chronic non-cancer pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. Pain Phys, 2017; 20(2s):S3–s92.

11.

Sacco

, Cagle

, Moreland

, et al. Screening and Assessment of Substance Use in Hospice Care: Examining Content from a National Sample of Psychosocial Assessments. J Palliat Med, 2017; 20(8):850–856; doi: 10.1089/jpm.2016.0538

12.

Blackhall

, Alfson

, Barclay

. Screening for substance abuse and diversion in Virginia hospices. J Palliat Med, 2013; 16(3):237–242; doi: 10.1089/jpm.2012.0263

13.

Childers

, Arnold

. “I feel uncomfortable ‘calling a patient out’”: Educational needs of palliative medicine fellows in managing opioid misuse. J Pain Symptom Manage, 2012; 43(2):253–260; doi: 10.1016/j.jpainsymman.2011.03.009

14.

Merlin

, Patel

, Thompson

, et al. Managing chronic pain in cancer survivors prescribed long-term opioid therapy: A national survey of ambulatory palliative care providers. J Pain Symptom Manage, 2019; 57(1):20–27; doi: 10.1016/j.jpainsymman.2018.10.493

15.

Morgan

. Nursing attitudes toward patients with substance use disorders in pain. Pain Manag Nurs, 2014; 15(1):165–175; doi: 10.1016/j.pmn.2012.08.004

16.

Quinn

. Institutional denial or minimization: Substance abuse training in social work education. Subst Abus, 2010; 31(1):8–11; doi: 10.1080/08897070903442475

17.

Russett

, Williams

. An exploration of substance abuse course offerings for students in counseling and social work programs. Subst Abus, 2015; 36(1):51–58; doi: 10.1080/08897077.2014.933153

18.

Minnick

. The state of substance use education in Master of Social Work programs: A content analysis of course listings and faculty profiles. Subst Abus, 2019; 40(2):194–200; doi: 10.1080/08897077.2018.1550466

19.

Hsieh

, Shannon

. Three approaches to qualitative content analysis. Qual Health Res, 2005; 15(9):1277–1288; doi: 10.1177/1049732305276687

20.

Ebenau

, Dijkstra

, Ter Huurne

, et al. Palliative care for patients with substance use disorder and multiple problems: A qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience. BMC Palliat Care, 2020; 19(1):8; doi: 10.1186/s12904-019-0502-x

21.

Merlin

, Young

, Arnold

, et al. Managing opioids, including misuse and addiction, in patients with serious illness in ambulatory palliative care: A qualitative study. Am J Hosp Palliat Care, 2020; 37(7):507–513; doi: 10.1177/1049909119890556

22.

Witham

, Galvani

, Peacock

. End of life care for people with alcohol and drug problems: Findings from a Rapid Evidence Assessment. Health Soc Care Community, 2019; 27(5):e637–e650; doi: 10.1111/hsc.12807

23.

Jones

, Ho

, Sager

, et al. Adapting palliative care skills to provide substance use disorder treatment to patients with serious illness. Am J Hosp Palliat Care, 2022; 39(1):101–107; doi: 10.1177/1049909121999783

24.

Chua

, Fratt

, Ho

, et al. Primary addiction medicine skills for hospice and palliative medicine physicians: A modified Delphi Study. J Pain Symptom Manage, 2021; 62(4):720–729; doi: 10.1016/j.jpainsymman.2021.02.035

25.

Baxter

, Sr., Campbell

, Deshields

, et al. Safe methadone induction and stabilization: Report of an expert panel. J Addict Med, 2013; 7(6):377–386; doi: 10.1097/01.ADM.0000435321.39251.d7

26.

Cook

, Levinson

, Garside

, et al. Internet-based learning in the health professions: A meta-analysis. JAMA, 2008; 300(10):1181–1196; doi: 10.1001/jama.300.10.1181

27.

Lanken

, Novack

, Daetwyler

, et al. Efficacy of an internet-based learning module and small-group debriefing on trainees' attitudes and communication skills toward patients with substance use disorders: Results of a cluster randomized controlled trial. Acad Med, 2015; 90(3):345–354; doi: 10.1097/acm.0000000000000506

28.

Day

, Srinivasan

, Der-Martirosian

, et al. A comparison of Web-based and small-group palliative and end-of-life care curricula: A quasi-randomized controlled study at one institution. Acad Med, 2015; 90(3):331–337; doi: 10.1097/acm.0000000000000607

29.

Chen

, Kern

, Kearns

, et al. From modules to MOOCs: Application of the six-step approach to online curriculum development for medical education. Acad Med, 2019; 94(5):678–685; doi: 10.1097/acm.0000000000002580

30.

Jackman

, Scala

, Nwogwugwu

, et al. Nursing attitudes toward patients with substance use disorders: A quantitative analysis of the impact of an educational workshop. J Addict Nurs, 2020; 31(3):213–220; doi: 10.1097/jan.0000000000000351

31.

Zickafoose

. Substance use disorder: Efficacy of educational strategies in Delaware. J Contin Educ Nurs, 2018; 49(1):42–48; doi: 10.3928/00220124-20180102-09

32.

Tuchman

, Hanley

, Naegle

, et al. Integration and Evaluation of Substance Abuse Research Education Training (SARET) into a Master of Social Work program. Subst Abus, 2017; 38(2):150–156; doi: 10.1080/08897077.2017.1291465

33.

Baumrucker

, Carter

, VandeKieft

, et al. Diversion of opioid pain medications at end-of-life. Am J Hosp Palliat Care, 2009; 26(3):214–218; doi: 10.1177/1049909109336005

34.

Ware

, Cagle

, McPherson

, et al. Confirmed medication diversion in hospice care: Qualitative findings from a national sample of agencies. J Pain Symptom Manage, 2021; 61(4):789–796; doi: 10.1016/j.jpainsymman.2020.09.013

35.

Cagle

, McPherson

, Frey

, et al. A national survey of challenges faced by hospices during the opioid crisis: Estimates of pain medication shortages, missing medications, and opioids left in the home post-death. J Pain Symptom Manage, 2021; 62(4):738–746; doi: 10.1016/j.jpainsymman.2021.02.023

36.

Ware

, McPherson

, Barclay

, et al. Recommendations for preventing medication diversion and misuse in hospice care: A modified Delphi Study. J Pain Symptom Manage, 2021; 62(6):1175–1187; doi: 10.1016/j.jpainsymman.2021.06.004

37.

Dunning

. Chapter Five—The Dunning–Kruger Effect: On Being Ignorant of One's Own Ignorance. In: Advances in Experimental Social Psychology. (Olson JM, Zanna MP. eds.) Academic Press: Netherlands; 2011; pp. 247–296.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

Caring for Patients With Opioid Misuse or Substance Use Disorders in Hospice: A National Survey

Abstract

Background:

Objectives:

Design:

Results:

Conclusions:

Get full access to this article

References

Supplementary Material