Team Seeks to Improve Pain Management for Rural Hospice Patients

In the final months of his life, Edward’s chronic illness worsened considerably. Both he and his wife, Ruth, realized they needed more help, so they called hospice. With the support of hospice, the couple was able to get Edward’s symptoms under control, and Edward ultimately died peacefully at home with Ruth by his side.

Ruth later shared this information with her aunt, describing how pleased she was that Edward’s death had been peaceful. Even today, Ruth remembers how her aunt responded when she learned that Edward had been given morphine in his final days: “Ruth,” she said, “that’s murder.”

Pain Management Concerns are Common in Hospice

The comment made by Ruth’s aunt reflects a common misperception about the use of pain medications in hospice. The reality is that hospice professionals are pain management experts, and they prescribe only the dose of medication necessary to manage a patient’s symptoms. Other common concerns about pain management at end of life include:

–              Fears about medication side effects and addiction;

–              Concerns about being seen as weak if pain is reported;

–              Belief that pain is unavoidable during the dying process.

Research suggests that rural hospice patients and their families are especially likely to express these concerns about pain medication, particularly if they live in communities where misuse of pain medications is common.

A team led by Dr. John Cagle, a hospice researcher at the University of Maryland, has devised a strategy to help hospice teams support patients and families with concerns about pain management. Hospice agencies implementing this strategy, called EMPOWER (Effective Management of Pain: Overcoming Worries to Enable Relief), directly assess patients and families’ pain management concerns. They then provide them with education and support tailored to their unique needs using EMPOWER’s evidence-based educational materials.  

With generous support from Hospice Foundation of the Ozarks, a team from Washington University in St. Louis is working to bring EMPOWER to hospice agencies across Missouri, particularly in rural communities where the strategy may be most needed.

Do You Have Ideas to Share? Are You Interested in Learning More?

If you’re interested in learning more about efforts to bring EMPOWER to rural Missouri hospices, email Dr. Karla Washington at