[RNSUEIA]

I have a patient with pancreatic cancer that I have managed for approx 2 weeks now. It seems like nothing I say gets through to the wife in regard to pain management. I believe this is due to her own fears of pain. She told me one day that she doesnt think her husbands pain is "that bad". She did then say "but its not my pain".
She definitly wont give morphine. "makes him too sleepy and glassy eyed, like he's over medicated" The vicodin she gives maybe twice a day and then only one pill. I have encouraged her to give the vicodin at scheduled intervals and have discussed with her about preventing pain. OMG...........any pointers????????

[AtlantaRN]

it is difficult to change deep seated beliefs. I had a family that just refused morphine for the mom with colon cancer because "her sisters had cancer and once you say morphine it's near the end." educated family on long term oxycodone and how my own husband has chronic pain issues and has been on for several years. FINALLY, they agreed to use it because it said "roxinol" on the bottle....

linda

[Sabby_NC]

Hmmmmmmm I read your post and wondered first off, is this an ethnic reason for withholding pain medication.
Due to their ethnicity, some people, do not take pain medication for what ever their beliefs are.
Is your patient coherent enough to ask for pain medication?
Is your patient coherent enough for you to sit and discuss his pain medications with him? Find out his level of pain when it is good, worse and what it is for him while you are visiting?
Yes education is ongoing with our families and patients until the day the patient dies.
Remind the wife that you appreciate her thoughts but she is not the one with the pancreatic cancer or the pain. Well maybe not so bluntly as I have stated.
Have you tried doing a chart with a scheduled dosing for her to follow. Although this is not always a good thing with pain.
What about requesting ER MS Contin where he is only taking one morning and night which may appease his wife. Then have the vicodin for break through if needed?
Keep slogging along for the sake of your dear patient.
Ahhhhhhh don't you just love a challenge?

[tencat]

Hmmmm.......do you have social workers available? Maybe a pastor (if patient has elected spiritual care) or physician who rounds on patients in their homes? Unfortunately, undermedicating of patients by family is REALLY common in my experience. Some people just will not use any of the pain medications, period. When I've had cases like that where I've educated until I'm blue in the face with no luck, I've pulled in our doc or a social worker, or our pastor. If the family can see it from a different point of view, a lot of times they will understand better (for example, morally is it right to let someone suffer?) If the patient does not want the medications, that is a whole different ball game.

[sharlynn]

I am amazed at the number of people who feel this way! HELLO....This is Hospice!
I agree with getting a pastor or SW to talk with her. Good luck!

[caliotter3]

I often run into people who still place a little skepticism in there if it comes from the nurse. I would suggest finding some printed studies, or materials about pain management written for the lay person and written by authorities and bring these to the lady. It might help for her to see info from authorities that contradict any misconceptions she may have. You don't even have to get into a long go around with her. Just say that you found some printed material for her to read that might better explain the subject and you can discuss the matter again at a later time. Good luck in getting her to come around. I feel sorry for her husband. You also might want to enlist the help of the doctor(s) involved. Again, using the authority figures to help. Many from older generations still look to authority figures for guidance.

[earle58]

how about a fentanyl patch, with vicodin hp for breakthrough?

i find that families don't put up as much of a fight, when they can't see/observe the med in action.
the patch would be conveniently hidden, leaving the wife to administer anything for breakthrough.
and a vicodin hp, doesn't look much different than the standard strength.

leslie

[Valerie Salva]

If you can get a very simply written pamphlet on cancer pain myths and facts, plus have someone in "authority" such as a doc speak to the wife, I find that these things usually take care of the problem.

Also, as Earle said, usually Fentanyl patches help. They are "out of sight, out of mind" and some families are more accepting of them then other methods of pain control.

[CANRN]

Originally Posted by Valerie Salva

If you can get a very simply written pamphlet on cancer pain myths and facts, plus have someone in "authority" such as a doc speak to the wife, I find that these things usually take care of the problem.

Also, as Earle said, usually Fentanyl patches help. They are "out of sight, out of mind" and some families are more accepting of them then other methods of pain control.

I have used handouts about pain medications myths, etc with some success. But what I have found works, it's explaining to the family about cancer pain WHAT it is doing to the body, organs etc and when they understand the disease process and what is going on, they start using the ROxinol or whatever is ordered. After a few days, they realize that Dad, Mom, Grandma or whoever we are treating, is not awake as much but when they are, they smile, they eat better and actually have some "quality time". THAT is when I am soooo happy and grateful I am a hospice nurse. Seeing a family get that quality time with their loved one makes all the frustrations go away!

[Hospice Nurse LPN]

Hmmmm.....at first I thought you were discussing MY patient.

With my patient is was a cultural/ethnic thing. The poor man had dilaudid 4mg, vicoden 7.5mg, and xanax 0.5mg. His wife would only given him 1 or 2 vicoden a day! Everytime I made a visit, he would be in such pain. She stated time after time that she "didn't want him hooked". They had a grandson in prision for drugs. I taught, taught, and then taught again, but it didn't seem to get through.

I agree with tencat. I had the doc make a visit. He was only there 10 minutes or so, but what a difference that made. Some people just think the doctor knows better and will listen to him/her and FOLLOW DIRECTIONS when the nurse has been saying the same thing all along. My patient FINALLY has his pain under control!