# A hospice nurse is caring for a 78-year-old patient with end-stage pancreatic cancer who is experiencing severe pain despite current medication regimen. The patient's family is concerned about increasing the morphine dose due to fear of addiction. What is the most appropriate nursing intervention? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543605 > language: ko > subject: Next Gen NCLEX ## 문제 A hospice nurse is caring for a 78-year-old patient with end-stage pancreatic cancer who is experiencing severe pain despite current medication regimen. The patient's family is concerned about increasing the morphine dose due to fear of addiction. What is the most appropriate nursing intervention? ## 보기 1. Reassure the family that addiction is not a concern and increase the morphine dose immediately without further discussion. 2. Suggest the family consider switching to non-pharmacological pain management methods only. 3. Recommend decreasing the morphine dose to address the family's concerns about addiction. 4. Educate the family about the difference between physical dependence and addiction, emphasizing that pain control is the priority in end-of-life care. **✔ 정답** **정답: 4** ## 해설 Educate the family about physical dependence vs. addiction to prioritize pain control in end-of-life care. Other options either dismiss concerns, avoid opioids, or reduce pain management inappropriately. ## 심화 해설 Understanding the Clinical Scenario This question addresses a critical and common barrier in end-of-life care: the fear of addiction when using opioids like morphine for severe cancer pain. The patient has end-stage pancreatic cancer and is experiencing severe, uncontrolled pain. The family's concern, while well-intentioned, stems from a misunderstanding of key concepts in palliative care. The priority is to manage the patient's suffering effectively while addressing the family's fears through education. Analyzing the Options **Option 1** dismisses the family's concerns and proceeds unilaterally. This approach breaks therapeutic communication and trust, which are essential in hospice care. Pain management requires a collaborative approach with the patient and family. **Option 2** suggests abandoning pharmacological management for non-pharmacological methods only. For severe, end-stage cancer pain, the World Health Organization's analgesic ladder indicates that non-opioid and adjuvant therapies are insufficient; strong opioids like morphine are the cornerstone of treatment. **Option 3** prioritizes the family's unfounded fear over the patient's clinical need. Decreasing a morphine dose that is already failing to control severe pain would lead to unnecessary suffering and is a direct violation of the ethical principle of beneficence. **Option 4** is the correct intervention. It directly addresses the core issue—a knowledge deficit regarding the difference between physical dependence and addiction (substance use disorder). In end-of-life care, the ethical and clinical priority is effective pain relief, which often requires escalating doses to match the patient's increasing physiological need. Deep Dive: Physical Dependence vs. Addiction The family's fear is rooted in a common misconception. The comprehensive review by Cordero-Pérez et al. [1] clarifies that opioids exert their effects through central and peripheral nociceptive pathways. With regular, long-term use, the body adapts physiologically, leading to physical dependence. This is a normal neurobiological response where abrupt cessation or a rapid dose decrease causes a withdrawal syndrome. It is not a sign of addiction. Addiction, or substance use disorder, is a complex psychological and behavioral condition characterized by compulsive drug-seeking behavior, loss of control over use, and continued use despite harm. A patient with severe, unrelenting cancer pain who is taking morphine for analgesia is not exhibiting these behaviors; they are seeking relief from suffering. The study by Kweh et al. [2] highlights that inadequate knowledge and negative perceptions among healthcare professionals are significant barriers to effective cancer pain management. This same knowledge gap exists in families and must be addressed with compassionate, evidence-based education. The Priority of Pain Control in End-of-Life Care In the context of terminal illness, the ethical framework shifts. The principle of double effect and the overwhelming focus on comfort and dignity make adequate analgesia the paramount goal. The risk of respiratory depression, while a clinical consideration, is managed through careful titration, and tolerance to this effect develops. The risk of true addiction in a patient with no prior history of substance misuse is exceedingly low. The nurse must explain that increasing the morphine dose is a medically necessary response to escalating pain and disease progression, not a sign of addictive behavior. The goal is to allow the patient to spend their final days with dignity, free from pain, and surrounded by family who understand the treatment's purpose. ## 임상 시나리오 Addressing Opioid Fears in HospiceDifferentiating Dependence from Addiction When families express fear of addiction, first validate their concern, then provide clear education. Explain that physical dependence is a normal physiological response to long-term opioid use, causing withdrawal if stopped abruptly. In contrast, addiction is a psychological disease involving compulsive drug-seeking behavior despite harm. For end-stage cancer pain, the clinical priority is pain relief. Use the WHO Analgesic Ladder as a framework: severe pain requires strong opioids like morphine. Uncontrolled pain can lead to pseudoaddiction, where behaviors mimic addiction due to inadequate dosing, resolving once pain is controlled. CautionNever withhold or reduce opioids solely due to fear of addiction in terminal illness. The ethical principle of beneficence mandates prioritizing comfort. Document education provided and involve the interdisciplinary team, including social work or chaplaincy, to support the family. ## 핵심 개념 - **Physical Dependence** — A state of adaptation manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, or administration of an antagonist. - **Addiction** — A primary, chronic, neurobiologic disease with genetic, psychosocial, and environmental factors characterized by impaired control over drug use, compulsive use, and continued use despite harm. - **Pseudoaddiction** — An iatrogenic syndrome of abnormal behavior developing from the undertreatment of pain, which mimics addiction but resolves with adequate analgesia. - **WHO Analgesic Ladder** — A three-step framework for cancer pain relief: Step 1 (non-opioid), Step 2 (weak opioid for mild-moderate pain), Step 3 (strong opioid for moderate-severe pain). - **Beneficence** — The ethical principle of acting for the patient's benefit, requiring the relief of suffering as a primary goal in end-of-life care. ## 같은 주제 문제 - [A nurse is caring for a 78-year-old patient with end-stage pancreatic cancer who has been …](https://mymerci.kr/pages/nclex_q.php?qn_id=543602) - [A hospice nurse is caring for a 72-year-old patient with end-stage lung cancer. 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