Sourcebook : Improving Care for the End of Life : 3.3 Define Patient and Provider Rights and Responsibilities

Some organizations write and post statements about pain management that explicitly describe patient rights and responsibilities, along with what to expect from health care providers. Such statements put into real, concrete terms what an institution believes it should do for patients and demonstrate a commitment to pain management. People are likely to trust and rely on organizations that make patient comfort a top priority.

Rely on Patient Self-Reports

Having patients report their pain intensity levels, and helping them to set goals for pain management, is critical to good pain management. However, patients may need guidance before they can describe or rate their pain intensity level. Organizations have an array of standard pain assessment tools from which to choose, as well as newer versions that meet patients' linguistic or expressive abilities. Using these starting points, teams can begin to apply the rapid-cycle model.

What Can Pain Do To You?
It Can Make You: Less able to function Tired and lethargic Lose your appetite or have nausea Unable to sleep or have disrupted sleep Experience less enjoyment and more anxiety Depressed, anxious, or unable to concentrate on anything else Feel a loss of control Limit contact with family and friends Be less able to enjoy affection Have a changed appearance Feel that you are a burden to families Suffer more Want to die Source: AHCPR, Management of Cancer Pain

What Can Pain Do To You?

It Can Make You:

Less able to function
Tired and lethargic
Lose your appetite or have nausea
Unable to sleep or have disrupted sleep
Experience less enjoyment and more anxiety
Depressed, anxious, or unable to concentrate on anything else
Feel a loss of control
Limit contact with family and friends
Be less able to enjoy affection
Have a changed appearance
Feel that you are a burden to families
Suffer more
Want to die

Source: AHCPR, Management of Cancer Pain

Statement on Pain Management
All patients have a right to pain relief. Health care providers will: Inform patients at the time of their initial evaluation that relief of pain is an important part of their care and respond quickly to reports of pain. Ask patients on initial evaluation and as part of regular assessment about the presence, quality, and intensity of pain and use the patients’ self-report as the primary indicator of pain. Work together with the patient and other health care providers to establish a goal for pain relief and develop and implement a plan to achieve that goal. Review and modify the plan of care of patients who have unrelieved pain. Source: Building an Institutional Commitment to Pain Management, The Wisconsin Resource Manual for Improvement, Wisconsin Cancer Pain Initiative, University of Wisconsin.

Statement on Pain Management

All patients have a right to pain relief. Health care providers will:

Inform patients at the time of their initial evaluation that relief of pain is an important part of their care and respond quickly to reports of pain.
Ask patients on initial evaluation and as part of regular assessment about the presence, quality, and intensity of pain and use the patients’ self-report as the primary indicator of pain.
Work together with the patient and other health care providers to establish a goal for pain relief and develop and implement a plan to achieve that goal.
Review and modify the plan of care of patients who have unrelieved pain.

Source: Building an Institutional Commitment to Pain Management, The Wisconsin Resource Manual for Improvement, Wisconsin Cancer Pain Initiative, University of Wisconsin.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].