Adult pain and anticipatory anxiety assessment in the emergency department: An integrative literature review

Abstract

Introduction Patients presenting to the emergency departments in pain often experience co‐occurring symptoms. Anticipatory anxiety in the emergency department may be currently under‐recognised. Clinical tools to facilitate the assessment of co‐occurring symptoms aligns with providing more patient centred care and improved outcomes and experience. Aims This integrative review aimed to identify and examine the psychometric properties of tools currently used for pain and anticipatory anxiety assessment in adult patients presenting to the emergency department. This study also aimed to identify the current clinical practice used to assess adult pain and anticipatory anxiety. Methods Whittemore and Knafl's methodology guided the review process, and it is reported according to relevant items from PRISMA checklist. Studies were included if they focused on tools for pain or anxiety assessment of adults in emergency departments in English language publications since 2010. Quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The results were summarised through narrative synthesis. Results A total of 15 studies were identified for narrative synthesis. Six tools for pain, and four tools for anticipative anxiety were found. All currently used clinical tools assess symptoms in isolation. There was limited discussion of the clinical context of identified tools within the included studies. Conclusion Pain and anxiety assessment are currently performed in symptom isolation with a variety of tools with varying degrees of reliability. There exists a lack of clinical tools able to assess co‐occurring symptoms of pain and anticipatory anxiety in the clinical setting of the emergency department. No studies discussed clinical tool use in current practice. Relevance to Clinical Practice The reconstruction of available pain and anxiety assessment tools into one validated and holistic tool for assessment in the ED clinical setting, would provide a contextually appropriate guide to clinical assessment and treatment. Acknowledging and measuring these symptoms may facilitate future rigorous testing of experimental studies of novel methods to reduce pain and anxiety in the ED. No Patient or Public Contribution Patient or public contribution does not apply to this Integrative Review. Clinical Trial Registration Number Not applicable.

Enhancing pain care with the American Pain Society Patient Outcome Questionnaire for use in the Emergency Department (APS-POQ-RED): validating a patient-reported outcome measure

“…The affective distress subscale comprising the degree to which the patient felt frightened, anxious, or helpless because of their pain, was the second subscale identified in the revised tool. Pain rarely exists without co-occurring symptoms such as anxiety (35,36) Alterations in the affective functioning of the patient can be a result of the pain, the lack of knowledge of the cause or the treatment, and receiving care in an environment that may be unfamiliar and imposing. The relationship between pain and affective distress is well acknowledged within the paediatric ED pain literature, with numerous interventions designed to reduce both (37)(38)(39)(40)(41)(42).…”

Enhancing pain care with the American Pain Society Patient Outcome Questionnaire for use in the emergency department (APS-POQ-RED): validating a patient-reported outcome measure

“…The affective distress subscale comprising the degree to which the patient felt frightened, anxious or helpless because of their pain was the second subscale identified in the revised tool. Pain rarely exists without co-occurring symptoms such as anxiety 35 36. Alterations in the affective functioning of the patient can be a result of the pain, the lack of knowledge of the cause or the treatment and receiving care in an environment that may be unfamiliar and imposing.…”

“…However, only 19% of PROs reported in the adult literature include emotional functioning as an outcome of pain care 3. A recent review of pain and anxiety measures in the adult ED found that no measure of the co-occurring symptoms of anxiety and pain had been reported in practice outside of quality improvement or research spheres 36. The acknowledgement of affective (emotional) distress as an outcome of effective pain care in the adult ED is the first step in acknowledging co-occurring symptoms (or symptom clusters) within the adult ED.…”