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How do healthcare workers judge pain in older palliative care patients with delirium near the end of life?*

Published online by Cambridge University Press:  20 October 2015

Lucia Gagliese ,
Rebecca Rodin ,
Vincent Chan ,
Bonnie Stevens  and
Camilla Zimmermann
Lucia Gagliese*
Affiliation:
School of Kinesiology and Health Science, York University, Toronto, Canada Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada Department of Supportive Care and Campbell Family Research Institute, University Health Network, Toronto, Canada Faculty of Medicine, University of Toronto, Toronto, Canada
Rebecca Rodin
Affiliation:
School of Kinesiology and Health Science, York University, Toronto, Canada Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
Vincent Chan
Affiliation:
Department of Anesthesia and Pain Management, University Health Network, Toronto, Canada Faculty of Medicine, University of Toronto, Toronto, Canada
Bonnie Stevens
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Canada Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada The Hospital for Sick Children, Toronto, Canada
Camilla Zimmermann
Affiliation:
Department of Supportive Care and Campbell Family Research Institute, University Health Network, Toronto, Canada Faculty of Medicine, University of Toronto, Toronto, Canada
*
Address correspondence and reprint requests to: Lucia Gagliese, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada, M3J 1P3. E-mail: gagliese@yorku.ca.
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Abstract

Objective:

Pain and delirium are commonly reported in older people with advanced cancer. However, assessing pain in this population is challenging, and there is currently no validated assessment tool for this task. The present retrospective cohort study was conducted to understand how healthcare workers (HCWs; nurses and physicians) determine that older cancer patients with delirium are in pain.

Method:

We reviewed the medical records of consecutive palliative care inpatients, 65 years of age and above (N = 113), in order to identify patient-based cues used by HCWs to make pain judgments and to examine how the cues differ by delirium subtype and outcome.

Results:

We found that HCWs routinely make judgments about pain in older patients with delirium using a repertoire of strategies that includes patient self-report and observations of spontaneous and evoked behavior. Using these strategies, HCWs judged pain to be highly prevalent in this inpatient palliative care setting.

Significance of results:

These novel findings will inform the development of valid and reliable tools to assess pain in older cancer patients with delirium.

Keywords

Cancer painOlder peopleDeliriumPalliative carePain assessmentChart audit
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 2: Measurement Development in Palliative and Supportive Care , April 2016 , pp. 151 - 158
Copyright
Copyright © Cambridge University Press 2015 

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Footnotes

*

Presented, in part, at the 34th Annual Scientific Meeting of the Canadian Pain Society, Winnipeg, Manitoba, Canada, in 2013.

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