End-of-Life Pain Management: Insights and Tips from Physicians

Illustration of a person with a beard resting in a hospital bed, covered by a blue blanket, as physicians focus on effective pain management. The room is softly lit, featuring two framed pictures on the wall.

Managing pain during end-of-life care is one of the most delicate and complex challenges physicians face. It’s a responsibility that requires both technical expertise and deep empathy. Yet, a recent survey of physicians on Sermo revealed just how unprepared many feel:

62% admitted they lacked sufficient training to make end-of-life care decisions.
11% expressed a lack of confidence.
30% confessed they’d never faced such decisions before.¹

These numbers highlight a crucial need for better support and resources to help healthcare professionals (HCPs) navigate these pivotal moments with confidence and compassion.

In this article, we’ll explore how doctors inside Sermo’s physician-only community approach end-of-life care, including their current challenges and what they think the future holds for palliative patients.

How physicians evaluate end-of-life pain management

Best practices in end-of-life care

Deciding to place a patient on hospice is a pivotal moment and 58% of surveyed physicians have faced this decision. But what guides their choice?

For many, maintaining the patient’s quality of life stands out as the most important factor (31%), followed by prognosis (24%), caregiver support (18%) and the patient’s wishes (16%).¹ As a Sermo member specializing in Hematology Oncology explains, “It’s about maintaining quality of life when patients run out of treatment options.²”

Severe pain is often a key indicator of declining quality of life, making it essential for physicians to focus on pain management in end-of-life care. So, how do they assess and measure pain to ensure their patients’ final days are as comfortable as possible?

A smiling physician in a white coat talks to an elderly man and woman about pain management, creating a warm and friendly atmosphere in the hallway.

How doctors on Sermo grade patients’ pain

Sermo members highlight the importance of a tailored approach to grading patients’ pain, recognizing that it manifests differently based on underlying conditions such as cancer, neurological disorders, or organ failure.

Personalized pain management ensures treatments address unique challenges, paving the way for compassionate care:

Patients with multiple comorbidities: Managing pain becomes even more complex. Balancing treatments for one condition without worsening another requires meticulous planning and collaboration across disciplines.
Patients with cognitive impairments: Diseases like Alzheimer’s demand attention to nonverbal cues—grimacing, restlessness, or posture changes—to assess discomfort effectively.

To measure pain intensity and its impact on quality of life, physicians on Sermo use practical tools and medication, including:

Pain scales: standardised tools like NRS and FPS for quick assessments.
Symptom tracking: diaries and apps to refine treatment.
Nonverbal observations: tools like PAINAD to assess patients who can’t communicate verbally.
Opioids: physicians and Sermo members emphasize the importance of careful dosing of opioids for end-of-life care. They highlight monitoring for side effects, and balancing efficacy in hospice pain management, with the potential risks of dependence or tolerance.¹

By combining these methods with multidisciplinary insights, physicians ensure patients receive compassionate care, maintaining dignity and comfort during their final stages.

Physicians’ practical barriers to effective end-of-life care

Providing effective pain relief during end-of-life care remains one of the most challenging aspects of medical practice.

A Sermo survey revealed 62% of physicians feel inadequately trained and 30% have never encountered such situations.¹ Addressing these gaps involves tackling practical barriers head-on.

Balancing autonomy with medical judgement

End-of-life care often presents a delicate balancing act between respecting a patient’s autonomy and applying clinical judgment.

According to Sermo, 42% of physicians prioritize open communication to empower patients in making informed decisions about their care.³ This commitment to dialogue ensures that patients understand their options and the potential outcomes.

Other physicians approach this balance in various ways:

16% focus on understanding patients’ values and aligning treatment plans accordingly.
20% emphasize building trust through clear information and collaborative decision-making.
7% highlight the importance of education and reassurance when patient choices diverge from medical advice.³

As one Dermatology physician noted, “Jimmy Carter made his own decision to enter hospice. That’s how it should be: up to the patient.²” This sentiment underscores the importance of honoring patient preferences–particularly regarding new clinical trials–while guiding them with compassion and expertise; physicians must prioritize open dialogue to empower patients while supporting them with evidence-based recommendations.

Ethical and legal considerations

Navigating the ethical and legal complexities of assisted dying is another significant barrier. Physicians must tread carefully, as laws and cultural attitudes differ widely across regions.

In response to the question, “How do you navigate the legal and ethical complexities of assisted dying?”, Sermo respondents highlighted their strategies:

32% focus on open and compassionate communication to explore patients’ wishes within an ethical framework.
23% stay informed about local laws and consult legal experts to ensure compliance.
16% collaborate with multidisciplinary teams to align decisions with ethical standards and the patient’s best interests.³

The importance of continued education is also evident, with 13% of physicians attending workshops on ethical dilemmas to enhance their decision-making.

As one GP explained, “Physicians may not feel comfortable making hospice care decisions due to a lack of training or experience. To address this issue, some medical schools and healthcare organizations have begun to offer specialized training and continuing education programs focused on hospice care.²”

France’s recent proposed legislation on assisted dying provides a case study in the complexities of this issue. While the bill aims to reconcile autonomy with solidarity, it’s sparked debate among HCPs. Dr Claire Fourcade, president of the French Society for Palliative Support and Care, cautioned that the urgent need remains for improved access to palliative care.⁴

According to Sermo members, this includes ongoing education, multidisciplinary collaboration and adherence to local regulations.

Two physicians in white coats converse in a well-stocked supply room, evaluating shelves brimming with various medical supplies and equipment crucial for end-of-life pain management.

Limited care teams

Effective end-of-life care requires input from multidisciplinary teams. However, the availability of such teams varies widely, limiting the quality of care and time to spend with patients in many settings. Sermo respondents identified key team members who support their efforts:

30% highlighted the role of specialty physicians, such as palliative care specialists and oncologists.
18% emphasized the importance of end-of-life nurses.
13% relied on hospice care specialists.³

Sermo members note that social workers, spiritual care professionals and bereavement counselors also play vital roles but are less commonly included. A Pediatrist stressed that “multidisciplinary care can help [patients] to have a better quality of life.²”

However, without adequate resources or dedicated teams, many physicians find themselves struggling to provide holistic care. Hence, greater investment in these approaches is needed.

Cultural and personal beliefs

Cultural and religious beliefs profoundly influence end-of-life decisions, shaping how patients and families approach care. According to a Sermo survey:

29% of physicians said these beliefs provide guidance and comfort.
22% stressed the importance of respecting diverse beliefs to personalize care.
14% acknowledged that cultural and religious beliefs can sometimes conflict with medical perspectives.³

Physicians must navigate these differences with sensitivity and respect.

As one GP shared, “A lot of people aren’t comfortable with [going into hospice care] based on beliefs, cultural practices and religion.2” However, inadequate training remains a barrier. Another GP noted, “There are no adequate training facilities in most of the country regarding hospice decision-making.²”

Therefore, expanding training to address cultural and religious considerations can enhance patient-provider relationships and improve care outcomes.

Physician perspectives on the future of assisted dying and palliative care

When asked about the future of assisted dying and palliative care, physicians on Sermo shared their diverse perspectives:

28% envision enhanced public awareness and education on end-of-life choices.
26% foresee a future where assisted dying and palliative care coexist.
20% stress the need for improved accessibility to palliative care.³

These views align with a broader global trend toward re-evaluating end-of-life care options.

Three healthcare professionals are in discussion, with one holding a pen and clipboard while another clutches eyeglasses. A stethoscope drapes around one individual's neck as they focus on end-of-life care strategies.

Lessons from France and the UK

France’s proposed bill on assisted dying underscores this shift, aiming to balance individual autonomy with strong palliative care standards.⁴

Meanwhile, in the UK, significant progress has been made with MPs supporting the Terminally Ill Adults (End of Life) Bill in November 2024.

Labour leader Sir Keir Starmer reinforced this momentum, stating, “I’m personally in favor of changing the law. I think we need to make time. We’ll make the commitment. Esther, I can give you that commitment right now.⁵“

While challenges remain, these legislative developments highlight a growing recognition of the importance of patient choice, with the inclusion of euthanasia increasingly seen as part of the future of end-of-life care.

Your takeaway

Managing pain during end-of-life care requires a balance of compassion, expertise and cultural sensitivity.

By addressing training gaps, embracing multidisciplinary collaboration and navigating evolving ethical landscapes, physicians can better support patients’ dignity and autonomy.

As global attitudes shift towards patient autonomy with a growing call for legalizing euthanasia, balancing the blend of patient wishes and physician expertise correctly will be crucial.