Current Use of Guidelines, Protocols, and Care Pathways for Symptom Management in Hospice

In the palliative treatment of patients in hospice, the effective management of both pain and non-pain symptoms is critical for alleviating distress and discomfort. Clinical guidelines such as integrated care pathways (ICPs) can help promote the delivery of high quality, evidence-based healthcare. This is particularly true in a hospice environment, where effective interventions depend on communication and planning among care givers from various disciplines. The authors conducted this study within the Population-based Palliative Care Research Network (PoPCRN) to characterize the current use and attitudes towards written symptom management materials in a hospice setting. They developed a survey tool to determine the presence of guidelines, protocols or care pathways in 128 hospice organizations associated with PoPCRN and then addressed material availability and use for 32 different symptoms. They analyzed data from 78 PoPCRN sites. Of those sites, 68 percent reported current use of written materials for symptom management and the vast majority of nursing directors reported both using these materials and finding them helpful (91 and 89 percent, respectively). Despite these responses, the authors found little evidence of a formalized mechanism linking symptom management research to clinical practice. In the authors' view, such a link is critical to improving symptom management in end-of-life care, though they recognize that this position is not supported by thorough research into the actual effect of ICPs on symptom management care. Limitations of this study include the authors' dependence on the perceptions of nursing directors, which may not necessarily accurately reflect the experiences of front-line care givers.