A hospice patient reports persistent pain. What is the priority nursing action?

• A. Reassess pain and adjust analgesia.
• B. Involve palliative care for optimal comfort.
• C. Increase activity and push through pain.
• D. Reassess pain and adjust analgesia; involve palliative care for optimal comfort.

Answer: (D)

When pain is persistent in a hospice patient, the priority is to optimize comfort through a thorough pain reassessment and an updated analgesic plan, with specialist support as needed. Start by re-evaluating the pain using the same scale, noting location, quality, timing, and any factors that worsen or alleviate it. Look for breakthrough pain and assess current dosing, routes, and whether the regimen matches the severity and patient goals. Based on that assessment, adjust analgesia thoughtfully—this may mean increasing the scheduled dose, adding or modifying a quick-acting analgesic for breakthrough pain, or switching to a more effective agent while weighing potential side effects and the patient’s organ function and preferences. After optimizing pharmacologic management, involve palliative care to fine-tune the plan, address refractory pain, manage side effects, and ensure the approach aligns with the goal of maximum comfort and quality of life.