This three page paper is a summary of searches run using the specific search question, "Does early referral of terminally ill patients into a hospice program result in better patient outcomes, in particular, with regard to pain management?" The search was broken down by term and three different engines were utilized. Search processes were recorded and resulting articles listed in APA format.
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 (1995). 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, Barry (1994). Ethical dilemmas in hospice and palliative care. Supportive Care in Cancer. Vol. 3(1), 28-36.
McKinlay, Eileen; McBain, Lynn (2007). Evaluation of the Palliative Care Partnership: a New Zealand solution to the provision of integrated palliative care. The New Zealand Medical Journal. Vol. 120(1263).
After this success, I would pose that the question is better stated as, "Does early entry into a hospice program result in better pain management?" The reason for the change from "early admitted" to "early entry" is that entry brought up much more accurate results. It would appear that entry is the term used within the medical community when referring to admittance into a medical program or department.
The next search I ran was on Medline. I first tried using the same search results as I did with the previous search, but the articles were less helpful. This time I added in the term "and" between the two search terms to see if this narrowed the results. This did not narrow the results at all, there were still 191 documents that came up. Next I tried adding the term "terminal care" in quotations and removed the term "Hospice." While the search widened to 240 documents the titles were more of what I wanted to see. The following was the most helpful titles on the first search page:
Improving Quality of end-of-life care. A possible and necessary change. Epidemiol Prev. August 2011.
I decided to try one more search on this database and put back the term hospice and added the terms "and admission. This brought up 16 new documents including the following:
"Assessing and treating pain in hospices: current state of evidence-based practices." J. Pain Symptom Manage. May 2010. From the lack of useful information obtained from this search site, my best conclusion is to keep the question the same, and continue on to the next search site.
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