Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer

UMMS Affiliation

Department of Quantitative Health Sciences; Clinical and Population Health Research Program, Graduate School of Biomedical Sciences

Publication Date


Document Type



Geriatrics | Health Services Administration | Pain Management | Palliative Care | Translational Medical Research


CONTEXT: Pain management is suboptimal in nursing homes.

OBJECTIVES: To estimate the extent to which receipt of hospice in nursing homes (NHs) increases the receipt of pain management for residents with cancer at the end of life.

METHODS: Study participants included Medicare beneficiaries with cancer who were NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in pain on hospice were matched to like residents without hospice by facility, type of pain assessment (self-report/staff assessment), and weeks until death (9064 matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided information on residents' pain prevalence and receipt of pain management (scheduled analgesics, as needed [pro re nata {PRN}] medication, nonpharmacologic interventions). We developed conditional logistic models to estimate the association between hospice use and pain management, stratified by self-reported and staff-assessed pain.

RESULTS: We found that pain prevalence was higher in residents using hospice versus those without hospice (e.g., residents who self-reported pain: hospice: 59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6% in hospice users and nonusers, respectively). Hospice use was associated with receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95% CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31, 95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain management were similar in residents with staff-assessed pain.

CONCLUSION: Untreated pain at the end of life among residents with cancer in NHs is unusual. Hospice is associated with increased pain management among those with documented pain.


UMCCTS funding, Nursing home, cancer, hospice, pain, pain management

DOI of Published Version



J Pain Symptom Manage. 2017 Mar;53(3):561-570. doi: 10.1016/j.jpainsymman.2016.10.369. Epub 2016 Dec 29. Link to article on publisher's site

Journal/Book/Conference Title

Journal of pain and symptom management

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Link to Article in PubMed

PubMed ID