title: Health-Care Workers' Judgments About Pain in Older Palliative Care Patients With and Without Delirium.
abstract: Delirium complicates pain assessment and management in advanced cancer. This retrospective cohort study compared health-care workers' (HCWs) cancer pain judgments between older patients with advanced cancer with and without a diagnosis of delirium. We reviewed HCWs' daily chart notations about pain presence and good pain control in 149 inpatients with advanced cancer, ≥65 years of age, admitted to a palliative care inpatient unit. Any day with 1 or more notations of pain presence was counted as 1 day with pain; days with notation(s) indicating good pain control were similarly counted. Proportions of days that HCWs judged inpatients to have pain and good pain control were calculated. Patients with and without a delirium diagnosis were compared on both pain outcomes. The moderating effect of highest analgesic class administered was examined. Although most patients received opioid analgesics, mean proportions of days with judged pain were high (39%-60%) and mean proportions of days with judged good pain control were low (<25%) across groups. Among patients receiving either opioid or nonopioid medication, patients with delirium demonstrated lower proportions of days with judged good pain control than patients without delirium ( P ≤ .001), even though groups did not differ in proportions of days with judged pain ( P = .62). Cancer pain is difficult to manage in advanced cancer, especially when delirium is present; however, misinterpretation of delirium symptoms as pain cues may inflate pain judgments. Findings require replication but suggest the need for better pain assessment in older patients with advanced cancer and delirium.
authors.affiliation: 1 Department of Anesthesia and Pain Management, Toronto General Hospital (K.M., R.A.R., and L.G.) and Toronto Western Hospital (V.W.S.C.), University Health Network, Toronto, Ontario, Canada.|2 Department of Supportive Care, Research Division, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.|Kenneth Mah and Rebecca A. Rodin contributed equally to this work and should be regarded as co-first authors.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mah
authors.affiliation: 1 Department of Anesthesia and Pain Management, Toronto General Hospital (K.M., R.A.R., and L.G.) and Toronto Western Hospital (V.W.S.C.), University Health Network, Toronto, Ontario, Canada.|3 School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada.|4 Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.|Kenneth Mah and Rebecca A. Rodin contributed equally to this work and should be regarded as co-first authors.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Rodin
authors.affiliation: 1 Department of Anesthesia and Pain Management, Toronto General Hospital (K.M., R.A.R., and L.G.) and Toronto Western Hospital (V.W.S.C.), University Health Network, Toronto, Ontario, Canada.|5 Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vincent W S
authors.initials: VWS
authors.lastname: Chan
authors.affiliation: 6 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.|7 Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|8 Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: Stevens
authors.affiliation: 2 Department of Supportive Care, Research Division, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.|9 Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: 1 Department of Anesthesia and Pain Management, Toronto General Hospital (K.M., R.A.R., and L.G.) and Toronto Western Hospital (V.W.S.C.), University Health Network, Toronto, Ontario, Canada.|2 Department of Supportive Care, Research Division, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.|3 School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada.|5 Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|10 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D000072716:Cancer Pain / Q000188:drug therapy / Q000523:psychology; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods*; D010166:Palliative Care / Q000458:organization & administration*; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D000701:Analgesics, Opioid
keywords: cancer pain; chart audit; delirium; older people; pain management; palliative care