title: Disparities Between Clinician and Patient Perception of Breakthrough Pain Control.
abstract: There are disparities in the level of symptom severity as perceived by patients and health professionals. There is limited information about patients' and clinicians' global assessment of breakthrough pain control, the need to change analgesics, and change in breakthrough pain over time.
  
  
  
  To establish whether patients and clinicians independently agree on adequacy of breakthrough pain control, management strategy, and impression of change over time.
  
  
  
  One hundred patients with breakthrough cancer pain were assessed and followed up one week later by a palliative medicine specialist. The patient and clinician independently answered the same questions about the adequacy of the patient's breakthrough pain control and breakthrough pain management. The results were compared with items on the Breakthrough Pain Assessment Tool (BAT).
  
  
  
  At initial consultation, 35% of patients rated their breakthrough cancer pain as inadequately controlled compared with 72% of clinicians. Breakthrough pain analgesics were changed in 68% of cases. At one-week follow-up consultation, 62% of patients considered their breakthrough cancer pain to be better, and in 57% of cases, the clinicians also categorized the pain this way.
  
  
  
  There are significant differences in global impressions of breakthrough pain between patients and pain clinicians that become less disparate as a therapeutic relationship evolves. Therapeutic decisions were based on clinical rather than patient perceptions.
authors.affiliation: Supportive and Palliative Care, St. Luke's Cancer Centre, Royal Surrey County Hospital, Surrey, United Kingdom. Electronic address: kwebber1@nhs.net.
authors.forename: Katherine
authors.initials: K
authors.lastname: Webber
authors.affiliation: Supportive and Palliative Care, St. Luke's Cancer Centre, Royal Surrey County Hospital, Surrey, United Kingdom.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Davies
authors.affiliation: National Heart & Lung Institute, Imperial College, London, United Kingdom.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D059390:Breakthrough Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D000072716:Cancer Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000523:psychology; D010147:Pain Measurement; D058748:Pain Perception; D010166:Palliative Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Cancer pain; breakthrough pain; outcome measurement; pain assessment; quality of life