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King's College London

Health

Socio-economic position and pain at the end of life

  • Observational studies demonstrate a high prevalence of pain towards end-of-life. Good pain relief is a basic human right everyone should have access to and a priority for patients and families.
  • People from minoritised ethnic groups, those experiencing homelessness, and people with poorer knowledge about health and the healthcare system are more likely to experience poorly controlled pain.
  • The evidence on the association between the financial situation of the individuals and their experiences of pain towards the end of life is mixed and, mostly limited to people with cancer. Furthermore, to our knowledge, no studies have been conducted in the UK.

Aims

To examine the association between subjective financial situation and pain during the last week of life, and the influence of access to and place of care on this association, in a nationally representative sample of people in England and Wales.

Hypotheses:

  • Lower socioeconomic position is associated with more pain in the last week of life, and difficulty accessing care is the pathway through which this occurs (i.e., a mediator).
  • Place of care in the last week of life may moderate the relationship between subjective financial situation and pain.

Methods

A retrospective nationally representative mortality follow-back survey study was conducted in 2023 in England and Wales (n=1,194). The survey was sent by the Office for National Statistics to family members of decedents whose deaths had been registered in the previous six to ten months, excluding sudden causes of death.

Impact

  • This research will provide a novel and up-to-date understanding of the association between financial situation and pain during the last week of life based on a nationally representative sample.
  • The additional mediation and moderation analyses will provide insights into system-level modifiable factors which may improve access to pain relief towards the end of life for different groups in society.
  • The findings will help in identifying people who are most at risk of experiencing severe pain at the end of life proactively and ensure they have access to pain relief.
  • Our findings will help identify priorities for future research studies to explore interventions for improving equitable palliative and end-of-life care delivery.
Project status: Ongoing

Principal Investigator