Introduction
Older adults may develop serious health issues that significantly affect their health. In particular, terminal illnesses like pancreatic cancer and other cancers are considerably lethal disorders and may have a dismal prognosis, and patients will die a few years after curative surgery. When the patient’s condition is in its advanced stages, it may not be cured, and she has to be admitted for palliative or end-of-life care. There is a need to adopt a treatment approach that allows control and manages symptoms. Adequate support is necessary for the patient to facilitate the patient and the family in dealing with the terminal illness and the problems that it causes.
At the end of life, palliative care is important in managing a patient’s symptoms and ensuring the patient has the highest possible quality of life. This approach recognizes that death is a natural and normal life process, and palliative care does not work to slow down or speed up death. Palliative care supports the patient and caregivers throughout the disease period. Palliative care can be offered in different settings alongside other treatments for pancreatic cancer and other healthcare issues. With terminal illnesses, patients and families will develop social, emotional, physical, and relationship issues that will significantly affect the quality of life for patients and their caregivers. Consistent support through palliative care helps to deal with these problems and promotes the patient’s well-being.
Increasing the patient’s comfort is significant at the end of life and allows the patient and family to approach death comfortably and to meet the different wishes that patients could have. In palliative care, the management of different symptoms and issues that affect patients’ comfort and quality of life is prioritized. Pain is a common symptom for most individuals with advanced and terminal illnesses. The pain is experienced in the back and the abdomen for pancreatic cancer. Usually, pain is different from one individual to the other and worsens at different times and in different situations. Therefore, pain medications are among the pharmacological interventions nurses need to apply during palliative care for patients with advanced and terminal illnesses. These medications aim to lower pain for the patients, increase comfort, and improve their quality of life at their end-of-life stages.
Nursing professionals should select the pain medications to assist patients’ pain management. Opioids are preferred options for managing pain in terminal illnesses like cancers. In particular, morphine is a unique medication to manage pain during palliative care and for individuals with pancreatic cancer (Payne et al., 2015). Healthcare professionals should supervise morphine intake since people could become addicted to it. These drugs must be taken at regular intervals to improve their effects on the patient.
Long-acting morphine is available in pills, and patients need to take the drug once or twice per day. The medication will increase pain management and improve patients’ comfort and quality of life (Wiffen et al., 2014). However, morphine comes with some side effects such as feeling sleepy, constipation, nausea, and other effects. These side effects would improve with time, and others would need treatment. In people undergoing palliative or hospice care, the nurse professionals should ensure that morphine is correctly administered and its side effects are managed for the patient. For patients unable to take the drugs orally, the nurses can administer the drug through injection. It would be necessary to use this approach alongside other pain management approaches to ensure this symptom is adequately managed and the patient can experience increased comfort. Research indicates that morphine is appropriate for pain management in cancer and terminally-ill patients. It results in increased quality of life for the patients in their end-of-life stages.
Search Strategy
The location of useful and dependable sources to inform the intervention for pain management is critical, and the right approach was used for the current paper. The initial search focused on searching electronic databases, and it used a significantly structured search approach. The search was carried out on reputable medical databases to locate the relevant studies, and it covered the periods between 2010 and 2022.
The text words and Mesh terms were used for MEDLINE and CINAHL databases to locate relevant articles for the current paper. The terms would be revised appropriately for each database to get more relevant studies for the paper. In particular, the terms used included ‘morphine, pain management, and end-of-life.’ The research articles that the search strategy located were individually assessed and screened for inclusion using specific criteria.
Inclusion criteria for selecting the relevant article were designed to suit the topic. The articles had to be on cancer and pain management in humans. The articles had original studies on morphine and its application in end-of-life care. The studies must have been carried out within the United Kingdom and completed in English. The studies included must have been published in the ten years.
Specific exclusion criteria were applied to exclude those studies that failed to meet the required standards. For example, incomplete studies and those that did not cover morphine for cancer pain management were excluded. The inclusion and exclusion criteria were meant to ensure only relevant and credible articles formed a part of the analysis.
Those articles that met the inclusion criteria were subjected to further analysis. They were subjected to quality appraisal to examine their methodologies, findings, and the different variables they were examining. The process allowed examining the quality of the research articles and their suitability in examining the role of morphine in managing pain during end-of-life care. The assessment examined the intervention, methodology, limitations, participants, and other factors. It was possible to determine whether the research articles were appropriate for use in the current paper with these aspects.
Mainly, the search strategy identified 175 articles in the two databases, which are the articles subjected to the inclusion and exclusion criteria. After this process, 143 articles were eliminated since they were incomplete, lacked appropriate interventions, and had methodological problems. The remaining articles were subjected to quality appraisal to examine different aspects of these articles and their relevance to the topic. This assessment led to the exclusion of 28 articles for varying reasons and elements that these articles presented. Out of the remaining four articles, three were used to inform pain management in cancer and terminally-ill patients in end-of-life care.
After the articles were selected, data was extracted from each of them. The data obtained from the studies included aims, methods, participants, and data collection approaches. The key findings were also obtained from the studies, which formed the basis for analyzing these articles’ findings.
Critical Analysis of Articles
Emanuel, G., Verne, J., Forbes, K., Hounsome, L., & Henson, K.E. (2021). Community prescribing for cancer patients at the end of life: a national study. BMJ Supportive & Palliative Care. https://web.archive.org/web/20210605144954id_/https://spcare.bmj.com/content/bmjspcare/early/2021/06/02/bmjspcare-2021-002952.full.pdf
The article aimed to examine the community prescriptions for individuals with cancer at the end of life. The drugs that patients receive at this stage should help enhance the quality of end of life for cancer patients by managing different issues and symptoms that patients go through. The study examined data from 57632 individuals who had died from malignant cancers in a care home or their homes in England in 2017. The community prescriptions that these individuals had received for symptom control in the last four months of their lives were evaluated. The findings of this national study indicated that these people received drugs for anticipatory prescribing and symptom control. The findings indicate the need for symptom control to enhance the end of life. Morphine is among the medications used for pain and symptom management.
The research subject for this study seems clear and appropriate. The scientific rationale is to understand community prescribing and the motivations behind it. It could assist in knowing different elements that could help enhance the quality of life for people at their end-of-life stages. The design used for the study involved acquiring data from Office for National Statistics (ONS) and using this information to examine the research subject. The design is appropriate for the research. The study used a large sample size, which reduces bias and improves the findings’ quality and generalizability. The study is ethical and has no harmful implications for the subjects. It meets all ethical standards and aspects.
The findings of this study indicate the role of medications for palliation and in end-of-life care for cancer patients. In particular, morphine and other opioids emerge as critical medications that could help in pain and symptom control for end-of-life care for cancer patients. In this way, this study emerges as an essential resource that would inform the current discussion and help understand the role that morphine plays in people’s end-of-life stages.
Wilson, E., Morbey, H., Brown, J., Payne, S., Seale, C., & Seymour, J. (2015). Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes. Palliative Medicine, 29(1), 60-70. https://journals.sagepub.com/doi/10.1177/0269216314543042
In this study, the authors aimed to examine the administration of anticipatory drugs to patients in end-of-life admission. Nurses should determine the medications they should use as anticipatory medications. It is critical to understand how the nurses make these decisions and the people’s concerns in making these decisions. The study adopted the ethnographic design in two regions in the United Kingdom and applied interviews and observations to collect data. The findings indicated that nurses use anticipatory medications to make the patients settled and comfortable through managing their symptoms. For example, they assist in managing agitation, pain, and other symptoms. The lowest possible dose should be used, and adherence to local prescribing policies is important. In implementing the anticipatory medications, nurses had to consider four conditions: the inability to use oral medicines, consent by patients when possible, independence of the decision from the influence, and irreversibility.
The research subject that the article addresses is relevant to the present paper in terms of intervention and clinical issues. Morphine is among the anticipatory medications that this article considers for end of life, making it an appropriate source of evidence for this paper. Also, the ethnographic design has been used appropriately and adequately for this study. It helps to understand the experiences of nursing professionals in using medications, including morphine, in the end-of-life stages. The research was carried out in adherence to ethical standards and considerations to ensure that participants do not experience any mental or physical harm.
The findings indicate the usefulness of medications in managing symptoms that patients have in their end-of-life stages. Morphine can assist in managing pain and make the patient comfortable. However, the article offers the elements that professionals should consider when using anticipatory medications. Thus, this study’s results would adequately inform the current research paper. It indicates morphine is a critical intervention in end-of-life care. Nurses engaged in palliative care could apply these findings to enhancing care and pain management for their patients.
Gardiner, C., Gott, M., Ingleton, C., Hughes, P., Winslow, M., & Bennett, M. I. (2012). Attitudes of health care professionals to opioid prescribing in end-of-life care: a qualitative focus group study. Journal of Pain and Symptom Management, 44(2), 206-214.
Opioids like morphine are key elements in palliative and end-of-life care for pain management. Applying these medications in palliative care is still not optimal, and many patients fail to receive adequate pain management in their end-of-life stages. In this study, the authors examined the healthcare professionals concerning opioid administration in end-of-life care. The data collection for the study happened in four focus groups and with thirty-one participants. Particular barriers affect the implementation of morphine and other opioids. The patients and their families have concerns, and the professionals have a role in addressing these concerns. This element would enhance pain management among individuals in their end-of-life stages.
The study has been correctly carried out and in line with the exploratory approach. The data collection seems appropriate, and the writing is flawless. The ethics committee approved the research, indicating that it met the necessary ethical standards. The findings are relevant to the research paper in the current case. Nurses learn how to educate patients and improve the acceptance of morphine and other opioids in managing pain, especially during end-of-life care.
Findings from Conducting the Critical Analysis
The articles indicate that medications, especially opioids, are common for patients in their end-of-life stages. Symptom management is a critical component in palliative and end-of-life care, and the medications are meant for this purpose. The primary goal of these forms of care is to enhance the patient’s comfort and increase the patient’s quality of life. Evidence indicates that symptom management allows offering care that enhances patient outcomes and improves the lives of family members. Some of the symptoms that terminally-ill patients have could be managed through pharmacological and non-pharmacological approaches. The nurses must determine the most important methods to control symptoms and enhance patient health and life outcomes.
The aims of palliative and end-of-life care are to make patients comfortable as their end of life comes near. As one faces death, the symptoms include pain, respiratory rattle, nausea, confusion, and anxiety (Emanuel et al., 2021). These symptoms would interfere with the quality of life of the patient. Therefore, medications that could manage these symptoms are critical in end-of-life and palliative care.
One of the disturbing symptoms is pain that most patients, especially those with advanced cancer cases, need adequate management. While there may be other interventions to manage pain, the three studies indicate opioids are a critical approach for managing the patient at the end of life. In some cases, especially in cancers, the pain and discomfort are significant and affect the patient’s quality of life. Thus, strong analgesics like opioids have to be used to deal with high modality pain and enhance patient comfort by addressing other symptoms.
Opioids manage moderate and severe pain in end-of-life care for different patient types. As the research articles indicated, they are among the most common sort after medications in this form of care. They would assist the patients in settling and ensure that they can have comfortable and painless death as death draws near (Wilson et al., 2015). The nursing professionals have to make the right choice regarding the opioid that would be used to adequately manage the pain and other symptoms that the patient could have.
Morphine is among the pain management approaches that are common in end-of-life care. Among all opioids taken for pain management, morphine is the most used (Emanuel et al., 2021). Nurses using this form of care indicate that using it makes the patient settled and comfortable in their lives. In the three articles, there is agreement on the role of morphine in pain management for individuals in their end-of-life stages.
The findings also indicate that the prescription of opioids like morphine increases with approaching death. Morphine allows people to manage better different mental and physical symptoms (Emanuel et al., 2021). However, the findings indicate some factors could prevent the full application of morphine and other opioids in end-of-life or palliative care (Gardiner et al., 2012). Nursing professionals must educate patients and families on this intervention and adopt measures to make patients and families willing to take morphine for pain management.
Also, the findings suggest the need for training, service planning, and delivery concerning morphine and opioids for pain management and symptom control for professionals, patients, and families (Emanuel et al., 2021). Essentially, this would allow increased comfort for the individuals with terminal illnesses whose deaths are fast approaching. It would enhance the patient’s situation.
Generally, the findings indicate pain management in palliative and end-of-life care could be managed through morphine or other opioids. These drugs are strong analgesics that would depress pain and control other terminally-ill patients’ symptoms. Morphine can be taken for pain management or as an anticipatory drug. Nursing professionals must ensure appropriate administration of morphine and other opioids and ensure that they realize the purpose for which they were administered. Adequate care is necessary to ensure the right dosage and effective management of different side effects that morphine could have. The drug should allow reduced pain, increased comfort, and high quality for the patient undergoing palliative or end-of-life care.
Conclusion
People come across different terminal illnesses that affect their lives and require adequate management. For example, cancers, in their advanced stages, lower the quality of life for people. The conditions are beyond cure at these late stages, and death resulting from them is inevitable. Such patients require admission into palliative or end-of-life care that would enhance their quality of life as they approach death. The management approaches should minimize pain and discomfort, and nursing professionals should put approaches to realize this goal. In the current situation, pain management in palliative care is the topic of concern. Usually, patients with terminal illnesses would experience high episodes of pain and discomfort that lower the patient outcomes and overall quality of life. In most studies, pain is an issue of concern in end-of-care, and nurses must commit to its management. Adoption of different pain management strategies may be essential at this stage. However, in some cases, the pain ranges from moderate to severe, indicating the need to use strong analgesics to manage pain in some situations.
The review of the article that informs pain management in end-of-life care started with the search for relevant and reliable sources of evidence. On both MEDLINE and CINAHL databases, numerous articles related to the use of morphine were identified. They were subjected to inclusion, exclusion, and quality appraisal to identify the most appropriate, relevant, and reliable evidence sources. Eventually, information was extracted from three articles to understand the use of morphine in managing pain and other symptoms in patients undergoing palliative and end-of-life care.
All articles were correctly carried through different designs and could promote, and they offered precise information that informs more on pain management in end-of-life care. The findings indicated opioids are among the most commonly used pain management approaches for people with terminal illnesses. These patients present with issues like pain and anxiety, and to enhance their quality of life, it will require strong pain relievers like opioids. The examinations of the articles indicate that morphine is among the commonly used opioids. It assists in dealing with pain and mental health issues – the comfort of the patient increases, which improves the quality of life for the patient. Thus, while morphine has its side effects on the patient, it assists in managing the pain significantly for the patient.
References
Emanuel, G., Verne, J., Forbes, K., Hounsome, L. & Henson, K.E. (2021). Community prescribing for cancer patients at the end of life: a national study. BMJ Supportive & Palliative Care. https://web.archive.org/web/20210605144954id_/https://spcare.bmj.com/content/bmjspcare/early/2021/06/02/bmjspcare-2021-002952.full.pdf
Gardiner, C., Gott, M., Ingleton, C., Hughes, P., Winslow, M. & Bennett, M.I, (2012). Attitudes of health care professionals to opioid prescribing in end-of-life care: a qualitative focus group study. Journal of pain and symptom management, 44(2), pp.206-214. https://doi.org/10.1016/j.jpainsymman.2011.09.008
Payne, S., Turner, M., Seamark, D., Thomas, C., Brearley, S., Wang, X., Blake, S. & Milligan, C. (2015). Managing end of life medications at home—accounts of bereaved family carers: a qualitative interview study. BMJ supportive & palliative care, 5(2), pp.181-188. doi: 10.1136/bmjspcare-2014-000658
Wiffen, P.J., Derry, S. & Moore, R.A. (2014). Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database of Systematic Reviews, (5).
Wilson, E., Morbey, H., Brown, J., Payne, S., Seale, C., & Seymour, J. (2015). Administering anticipatory medications in end-of-life care: a qualitative study of nursing practice in the community and in nursing homes. Palliative Medicine, 29(1), 60-70. https://journals.sagepub.com/doi/10.1177/0269216314543042
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