title: Not all suffering is pain: sources of patients' suffering in the emergency department call for improvements in communication from practitioners.
abstract: BACKGROUND
  Provision of prompt, effective analgesia is rightly considered as a standard of care in the emergency department (ED). However, much suffering is not 'painful' and may be under-recognised. We sought to describe the burden of suffering in the ED and explore how this may be best addressed from a patient centred perspective.
  
  
  METHODS
  In a prospective cohort study, we included undifferentiated patients presenting to the ED. We undertook two face to face questionnaires with the first immediately following triage. We asked patients: (a) if they were 'suffering'; (b) how they were suffering; and (c) what they hoped would be done to ease this. Prior to leaving the ED, we asked patients what had been done to ease their suffering. Data were analysed thematically.
  
  
  RESULTS
  Of 125 patients included, 77 (61.6%) reported suffering on direct questioning and 92 (73.6%) listed at least one way in which they were suffering. 90 (72.0%) patients had a pain score >0/10 but only 37 (29.6%) reported that pain was causing suffering. Patients reported suffering from both physical symptoms (especially pain, nausea, vomiting and dizziness) and emotional distress (notably anxiety). Treatment (to ease physical and emotional symptoms), information (particularly diagnosis, reassurance and explanation), care (notably friendly staff) and closure (being seen, resolving the problem and going home) were the key themes identified as important for relief of suffering.
  
  
  CONCLUSIONS
  In seeking to ease suffering in the ED, clinicians must focus not only on providing analgesia but on treating Emotional distress, Physical symptoms, providing Information, Care and Closure (EPICC).
authors.affiliation: Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK University of Manchester, Manchester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Body
authors.affiliation: University of Manchester, Manchester, UK.
authors.forename: Ergul
authors.initials: E
authors.lastname: Kaide
authors.affiliation: University of Manchester, Manchester, UK.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-8557-5716
authors.initials: S
authors.lastname: Kendal
authors.affiliation: Central Manchester University Hospitals Foundation NHS Trust, Manchester, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Foex
mesh_terms: D001007:Anxiety; D003142:Communication; D004636:Emergency Service, Hospital; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010817:Physician-Patient Relations; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: clinical assessment, effectiveness; communications; patient support; psychology, patient support