Context.It is difficult to distinguish the causes of oipiods analgesic efficacy decline in opioids tolerant hospice homing care patients.These factors usually present concurrently.Diverse strategies of analgesic adjustment are needed to cope with the decline.Few studies have compared their efficacy in hospice.Objectives.To examine the analgesic efficacy of opioid dose escalation,adjuvant analgesics,opioid rotation,and opioid tapering and to select effective and safe strategy for those patients who experienced the decline of analgesic efficacy.Methods.A retrospective data of 743 cases were reviewed.Pain scale was assessed using numeric rating scales and pain relief was made by 4-point scale.Ratio of analgesic efficacy and duration of opioid ongoing were employed to assess the effect,and opioids side effects were used to examine the safety.Results.Among diverse strategies,the analgesic efficacy and adverse effects were not significantly different in each analgesic adjustment,respectively.The duration of opioids ongoing was 30 to 50 days and there was no difference in each analgesic adjustment,respectively.The correlation between analgesic efficacy and clinical characteristics was not significantly different.Conclusion.For opioids tolerant hospice patients,no matter which prevenient strategies were administrated,the analgesic efficacies of sequent diverse strategies were similar when a decline of analgesic efficacy experienced.The results suggest that diverse strategies can be selected individually to provide expected effects.After repeatedly analgesic adjusted,the goal even can be obtained by using opioid tapering.