ABSTRACT
"Pain contracts" for patients receiving long-term opioid therapy, though well-intentioned, often stigmatize the patient and erode trust between patient and physician. This article discusses how to improve these agreements to promote adherence, safety, trust, and shared decision-making.
Subject(s)
Chronic Pain , Medication Therapy Management/ethics , Trust , Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Chronic Pain/psychology , Decision Making , Humans , Physician-Patient Relations/ethicsABSTRACT
PURPOSE: To determine whether a structured approach to end-of-life decision-making directed by a compassionate interdisciplinary team would improve the quality of care for patients with terminal illness in a teaching hospital in Ghana. FINDINGS: A retrospective analysis was done for 20 patients who consented to participate in the structured approach to end-of-life decision-making. Twenty patients whose care did not follow the structured approach were selected as controls. Outcome measures were nociceptive pain control, completing relationships, and emotional response towards dying. These measures were statistically superior in the study group compared to the control group. CONCLUSIONS: A structured approach to end-of-life decision-making significantly improves the quality of care for patients with terminal illness in the domains of pain control, completing relationships and emotional responses towards dying.
