AGREEMENT PATTERNS BETWEEN INPATIENT SELF REPORTED PAIN AND CARE PROVIDER EVALUATION. Background. Improper pain assessment compromises pain treatment. Albeit the patient's self-reported-pain (PSRP) provides the most valid measure of pain, medical judgment is often biased by features of the target, the assessor and of their interaction context. Agreement between PSRP and care providers pain estimation (CPPE) is often taken as a tool to uncover pain assessment biases. Aims of the study were to assess the PSRP-CPPE agreement in our hospital and the influence of inpatient, situational, and treatment moderators on the agreement patterns reveled. Methods. Overall 869 patients, ≥6 years old and hospitalised for at least 24 hours in 57 wards, reported current pain using 10cm Numerical-Rating-Scale; contemporarily, wards’ nurses estimated patients’ pain using the same scale and reported patient’s demographic, medical and treatment data. Total agreement was calculated by kappa statistics. Agreement patterns dependence upon independent moderators was defined by c2 analysis. Statistical significance: P < 0.05. Results. PSRP-CPPE agreement was found in 50% of the cases. Pain under-estimation was directly proportional to the PRSP severity; agreement and over-estimation were inversely proportional to it. Both patient (age, gender, marital status), situational (ward type, hospital stay) and pain treatment (absence, presence) moderators influenced PSRP-CPPE agreement. Conclusions. In this cross sectional study the PSRP-CPPE agreement was limited. The PSRP was a major moderator of the agreement patterns detected. The latter were further modulated by the studied moderators. Awareness of the underlined biases and the negative influence of patient stereotyping mechanisms on pain evaluation, may render pain assessment more accurate. 1. Chibnall JT et al. The effects of medical evidence and pain intensity on medical student judgments of chronic pain patients. J Behav Med 1997;20:257-271. 2. Solomon P. Congruence between health professionals' and patients' pain ratings: a review of the literature. Scand J Caring Sci 2001;15:174-180.
B. Samolsky Dekel, RM. Melotti, F. Carosi, GF Di Nino (2006). Agreement patterns between inpatient self reported pain and care provider evaluation..
Agreement patterns between inpatient self reported pain and care provider evaluation.
SAMOLSKY DEKEL, BOAZ GEDALIAHU;MELOTTI, RITA MARIA;CAROSI, FRANCESCA;DI NINO, GIANFRANCO
2006
Abstract
AGREEMENT PATTERNS BETWEEN INPATIENT SELF REPORTED PAIN AND CARE PROVIDER EVALUATION. Background. Improper pain assessment compromises pain treatment. Albeit the patient's self-reported-pain (PSRP) provides the most valid measure of pain, medical judgment is often biased by features of the target, the assessor and of their interaction context. Agreement between PSRP and care providers pain estimation (CPPE) is often taken as a tool to uncover pain assessment biases. Aims of the study were to assess the PSRP-CPPE agreement in our hospital and the influence of inpatient, situational, and treatment moderators on the agreement patterns reveled. Methods. Overall 869 patients, ≥6 years old and hospitalised for at least 24 hours in 57 wards, reported current pain using 10cm Numerical-Rating-Scale; contemporarily, wards’ nurses estimated patients’ pain using the same scale and reported patient’s demographic, medical and treatment data. Total agreement was calculated by kappa statistics. Agreement patterns dependence upon independent moderators was defined by c2 analysis. Statistical significance: P < 0.05. Results. PSRP-CPPE agreement was found in 50% of the cases. Pain under-estimation was directly proportional to the PRSP severity; agreement and over-estimation were inversely proportional to it. Both patient (age, gender, marital status), situational (ward type, hospital stay) and pain treatment (absence, presence) moderators influenced PSRP-CPPE agreement. Conclusions. In this cross sectional study the PSRP-CPPE agreement was limited. The PSRP was a major moderator of the agreement patterns detected. The latter were further modulated by the studied moderators. Awareness of the underlined biases and the negative influence of patient stereotyping mechanisms on pain evaluation, may render pain assessment more accurate. 1. Chibnall JT et al. The effects of medical evidence and pain intensity on medical student judgments of chronic pain patients. J Behav Med 1997;20:257-271. 2. Solomon P. Congruence between health professionals' and patients' pain ratings: a review of the literature. Scand J Caring Sci 2001;15:174-180.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
