Department of Thoracic Surgery, Sichuan Cancer Hospital
Inadequate assessment of a patient’s pain will lead to inadequate management of it. In perioperative (the time surrounding a surgical operation) practice, pain assessment is nurse-led and assessed. Previous studies showed poor correlation between patients’ self-reported pain and observer-reported pain. However, it is unknown whether the score of pain severity recorded during the nurse-led practice is representative of the patient’s actual pain experience.
A longitudinal cohort study was designed to exam to what extent the pain severities recorded in routine perioperative care were consistent with the scores reported by patients via a standard patient-reported pain scale. This study aimed to demonstrate the compliance with the standards of pain assessment in routine care, and ultimately to provide a reference point for improving pain management in practice.
In this study, nursing staff assessed pain of lung cancer patients during the perioperative period as a routine care. We found that these scores were poorly consistent with those reported by patients.
This result suggested a risk that pain assessment might be inadequate, which then means patients did not receive appropriate treatment. How to standardize the use of NCCN pain guidelines in clinical practice, as well as obtain reliable and realistic pain scores, is a topic worth exploring.
There are several influential factors that could affect the discrepancy in these scores, including the patients, the medical care provider, and the purpose of the assessment. The self-reported data had a higher proportion of moderate to severe pain, but also a lower data completion rate, which may be related to the data coming directly from the patients and low patient compliance. The consistency of severe pain assessment may be closely related to clinical assessment practices.
Therefore, the choice of pain assessment modalities, the development of effective quality control measures, and pain education for health professionals and patients are needed to be considered in depth for optimal pain management.
Patients in this analysis were derived from a multicenter, prospective cohort study (CN-PRO-Lung1) conducted in Sichuan Cancer hospital and 5 other hospitals in southwestern China from November 2017 to January 2020, ethical number: SCCHEC-02-2017-042, and all patients signed an informed consent form. Patients were assessed for the highest value of pain on the same day using two assessment tools. Data A were obtained via the pain item of MDASI-LC, a 0-10 NRS scale. Data B were extracted the highest pain score from the clinical electronic medical record system. Nurses recorded patients’ pain severities twice a day using the single item 0-10 NRS pain scale. SAS 9.4 software was used for statistical analysis.
Of the 354 patients, 191 (53.95%) were male and 163 (46.05%) were female, with a mean age of 55.64±10.34 years. The completion rate of pain assessment in the Data A ranged from 79.94% to 99.15% over the time of perioperative hospitalization. The consistency was poor for the proportion of pain between two ratings, with Kappa values <0.4 and P <0.05. The percentage of inconsistent severe pain was lowest before surgery (0.28%) and highest on postoperative day 1 (35.56%), decreasing gradually over time to 6.55% on the day of discharge. The results of binary logistic multifactorial regression analysis showed that single-port thoracoscopic surgical access as an influencing factor for inconsistent assessment of severe pain on postoperative day 3 [OR=2.571, 95% CI =1.332-4.440, P=0.005].
Abstract will be presented virtually in the Friday Afternoon Poster Presentations: Slot 5 on 21 October, 2:40 pm – 2:55 pm.
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