Evidence-Based Practice using PICO
The question posed for this search activity will be, "Does early referral of terminally ill patients into a hospice program results in better patient outcomes, in particular, with regard to pain management?" The patient group in this question is terminally ill patients. The intervention is terminally ill disease. The comparison is time entered into hospice care. The outcome is reduced pain. The primary search terms for this search are hospice and pain management. Synonyms for the search are in-home care, bereavement care, critical condition, deathbed, palliative, and anesthesia. The MeSh terms are Hospices, Terminal Care, Pain management and Chronic Disease.
Based on the located synonyms, the better phrasing of the question may be, "Do early admitted hospice patience have a better outcome regarding pain management?" The reason for shaving the question slightly is that only terminally ill patients can be admitted into hospices. So, the term does not necessarily need to be part of the actual question.
The first search that I ran was using CINAHL. I initially tried using the primary research terms placed separately in quotations. This brought up very vague searches with no helpful articles. The total amount of papers was 2,330. I next removed the term "terminally ill" and left the other two and the search titles became very useful articles but the total amount of articles increased. In total, there were 14,200 articles that came up with the search. This search brought up the following helpful articles on the first search page:
Berry, Patricia...
Barriers to pain management in hospice: A study of family caregivers. Hospice Journal. Vol 10(4), 19-33.
Fothergill-Bourbonnaise, Frances; Wilson, Jennifer (2006). A comparative study of intensive therapy unit and hospice nurses' knowledge on pain management. Journal of Advanced Nursing. Volume 17(3), 362-372.
Gloth, F. Pain Management in Older Adults: Prevention and Treatment. Journal of the American Geriatrics Society. Vol 49(2), 188-199.
Miller, Susan; Et al. (2002). Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life? Journal of the American Geriatrics Society. Vol 50(3), 507-515.
Miller, Susan; et al. (2003). Hospice enrollment and pain assessment and management in nursing homes. Journal of Pain and Symptom Management. Vol 24(3), 791-799.
I then decided to try using some of the synonyms for the search terms to see if I could narrow the total any further. I first tried using the terms early terminal care, placed in quotations. This brought up only three articles none of which were useful. For the next try, I used the terms early entry and hospice. Early entry was placed into quotations and hospice was left out of quotations. This resulted in 75 studies some of which were very helpful including the following:
Chow, E.; et al. (2000). How Accurate are Physicians' Clinical Predictions of Survival and the Available Prognostic Tools in Estimating Survival Times in Terminally III Cancer Patients? A Systematic Review. Clinical Oncology. Vol 13(3), 209-218.
Kinzbrunner,…
