Association between timely and standardized nursing pain management and outcomes in terminal cancer patients

Effective pain management is essential for terminal cancer patients in emergency settings, yet nursing protocol adherence remains suboptimal. This study aimed to evaluate the association between key nursing process indicators and pain relief outcomes in terminal cancer patients presenting to the emergency department (ED) and to examine clinical outcomes according to adherence to an optimized nursing pain management workflow. We conducted a retrospective cohort study involving 724 terminal cancer patients who visited the ED of the Affiliated Hospital of Southwest Medical University between January 2017 and December 2023. Eligible patients presented with pain as a primary complaint and had complete clinical and nursing documentation. Data were extracted on demographics, cancer type, pain scores, timing of analgesic administration, and reassessment practices. The primary outcome was effective pain relief, defined as a ≥2-point reduction on the numeric rating scale within 1 hour of analgesia. Multivariate logistic regression was used to identify independent predictors. Patients were stratified into an optimized care group (completion of pain assessment within 30 minutes, analgesia within 30 minutes, and reassessment within 1 hour) and a routine care group. Of the 724 patients included, 58.2% achieved effective pain relief. Multivariate analysis revealed that timely pain assessment (odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.26-2.69), analgesic administration within 30 minutes (OR = 2.24, 95% CI: 1.57-3.21), opioid use (OR = 1.52, 95% CI: 1.06-2.20), and documented pain reassessment (OR = 1.69, 95% CI: 1.22-2.35) were independently associated with improved pain outcomes. Patients in the optimized care group (n = 286) had significantly higher pain relief rates (75.9% vs 46.6%, P < .001), faster relief onset (29.6 ± 11.3 vs 52.7 ± 15.9 minutes, P < .001), shorter ED stays (3.4 ± 1.1 vs 4.7 ± 1.4 hours, P < .001), and lower 72-hour revisit rates (7.3% vs 21.0%, P < .001). Timely and standardized nursing interventions were associated with more favorable pain relief and emergency department care-efficiency outcomes among terminal cancer patients. These findings support the integration of structured nursing protocols into emergency palliative care, although prospective studies are needed to determine their causal effects.