Pain intensity assessment by bedside nurses and palliative care consultants: a retrospective study.
OBJECTIVE
To evaluate the specificity, sensitivity, and accuracy of pain intensity assessments (0-10) conducted by registered nurses (RN) and clinical nurse assistants (CAN) as compared to those conducted by the palliative care consultant (PCC).


METHODS
We performed a retrospective review of charts of patients who had received palliative care consult between April 2002 and August 2002. Data on patient demographic, date of palliative care consult, and date and intensity of pain assessment were collected. A numerical rating scale from 0 (no pain) to 10 (worst pain) was used to assess pain intensity. The data were included for analysis if the pain intensity assessment was performed during the same shift by all three care providers (RN, CNA, and PCC).


RESULTS
Forty-one charts were found to include a complete pain assessment performed by the RN, CNA, and PCC. The agreement of pain intensity between the PCC and both the RN and CNA was poor. For a diagnosis of moderate-to-severe pain, the RN's intensity assessment had a specificity of 90% but a sensitivity of 45%, and the CNA's intensity assessment had a specificity of 100% but a sensitivity of only 30%. The Spearman correlation coefficient between the intensity assessments performed by the PCC and the RN was 0.56 (p=0.00) and between those by the PCC and the CNA 0.22 (p=0.15).


CONCLUSIONS
Lack of agreement between pain intensity assessments performed by the PCC and bedside nurse suggests possible inconsistencies in the way the assessments were performed. Better education on how to perform standard pain intensity assessment is needed.
Bruera
Eduardo
E
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA. ebruera@mdanderson.org
Willey
Jie S
JS
Ewert-Flannagan
Patricia A
PA
Cline
Mary K
MK
Kaur
Guddi
G
Shen
Loren
L
Zhang
Tao
T
Palmer
J Lynn
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003253:Consultants; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D009741:Nursing Staff, Hospital; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement; D010166:Palliative Care; D010362:Patients' Rooms; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013781:Texas