title: How do healthcare workers judge pain in older palliative care patients with delirium near the end of life?
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  These novel findings will inform the development of valid and reliable tools to assess pain in older cancer patients with delirium.
authors.affiliation: School of Kinesiology and Health Science,York University,Toronto,Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
authors.affiliation: School of Kinesiology and Health Science,York University,Toronto,Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Rodin
authors.affiliation: Department of Anesthesia and Pain Management,University Health Network,Toronto,Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chan
authors.affiliation: Faculty of Medicine,University of Toronto,Toronto,Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.affiliation: Department of Supportive Care and Campbell Family Research Institute,University Health Network,Toronto,Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D003693:Delirium / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000451:nursing*; D009726:Nurses / Q000523:psychology / Q000592:standards; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies
keywords: Cancer pain; Chart audit; Delirium; Older people; Pain assessment; Palliative care