We work with a wide range of organizations on an ongoing basis to ensure best practices for hospice and palliative care in New Hampshire.

A Hospice Quick Guide outlining Medicare Hospice Eligibility Guidelines reflecting the current 2012 CMS criteria for determining eligibility for Hospice services has been prepared by the NHHPCO Palliative Care Clinicians Special Interest Group. As part of the ongoing 'Best Practices Project', promoted by our Palliative Clinician Group, this laminated card is meant to be an easy-to-carry assessment tool.

Opioid Use Guidelines have been prepared by the NHHPCO Palliative Care Clinicians Special Interest Group as part of their 'Best Practices Project' and reflect prescribing "best practices" for 2010.

Both cards can be ordered through the NHHPCO Store.

The NHPCO has provided us with their Staffing Guidelines for Hospice Home Care Teams.

The Visiting Nurse Association of America has released an issue brief on Best Practices in Hospice and Palliative Care: Strategies to Ensure a Comfortable Death with Dignity.

Highlights from the Quality of Life Task Force

"Pain associated with cancer can almost always be relieved, yet it is a problem in at least 60% of patients in active treatment. Cancer Related pain can devastate quality of life - affecting work, appetite, sleep and time with family and friends."

-- ACS Cancer Action Network

The Quality of Life Task Force of the NH Comprehensive Cancer Collaboration (NH CCC) conducted a survey in January of 2016 to determine current pain assessment and management practices in NH cancer care centers. The specific area of interest is to determine the scope of interventions currently offered to patients living with cancer pain for relief and prevention of pain. Surveys were emailed to all Cancer Care Centers yielding a response rate of 100 percent.

To complete our project, a rack card has been developed to provide education and awareness about evidence based non-pharmacological interventions and resources that staff can present to the patient. Interventions listed on our card have been vetted by the American Cancer Society, Oncology Nursing Society, and the National Comprehensive Cancer Network.

For copies of the card email Janice McDermott, NHHPCO Exec. Dir. and co-leader of the Quality of Life Task Group.

Major findings from the survey:

  • The majority of organizations (96%) responding to the survey report their pain assessment is a verbal rather than a written process.
  • 100% of organizations responding to the survey report referrals to evidence-based, non-pharmacological interventions to treat and/or prevent pain. *See below
Graph of what survey participants offer or refer out for pain relief intervention

Chronic Pain

Chronic pain affects an estimated 100 million Americans and an untold number of people are affected by acute pain. According to a recent report issued by the National Institutes of Health, between 40 and 70 percent of people with chronic pain are not receiving proper medical treatment. While much attention is being given to the rise in abuse, misuse and diversion of prescription pain medications, many people still receive inadequate pain assessment and treatment.

The NH Comprehensive Cancer Collaboration Quality of Life Task Force is currently working on a project with participation from NHHPCO to "decrease the percentage of persons living with cancer who report unmanaged pain." This strategy was initiated in response to the following objective in the State Cancer Plan - Increase availability and access to systems that provide relevant, evidence based and / or recommended survivorship programs and services designed to improve quality of life.

The Task Force is connecting with each Cancer Center in NH to create a baseline of current pain assessment and intervention practices. We have learned that centers do not routinely ask patients if the level of pain that they report is acceptable to them. The Task Force would like to improve patient involvement in when and what types of interventions are offered.

Communication is the cornerstone of superb palliative care, according to the Harry J. Duffey Family Pain and Palliative Care Program at the Johns Hopkins Kimmel Cancer Center.

You can help by using the list below as a guide to encourage your patients to be as specific as possible when describing their pain.

  • Aching
  • Cramping
  • Fearful
  • Gnawing
  • Heavy
  • Hot or burning
  • Sharp
  • Shooting
  • Sickening
  • Splitting
  • Stabbing
  • Punishing or cruel
  • Tender
  • Throbbing
  • Tiring or exhausting

NHPCO Prognosis Video

Jennifer Kennedy of NHPCO has provided us with a video and PDF detailing hospice prognosis procedures.