Development and preclinical testing of the critical care pain observation tool for family caregiver use (CPOT‐Fam)

Abstract

Background and Aims Pain assessment in noncommunicative intensive care unit (ICU) patients is challenging. For these patients, family caregivers (i.e., family members, friends) may be able to assist in pain assessment by identifying individualistic signs of pain due to their intimate patient knowledge. This study adapted the critical care pain observation tool (CPOT) to facilitate pain assessment in adult ICU patients by family caregivers. Methods This study was conducted through three distinct phases: CPOT adaptation for family caregiver use (to create the CPOT‐Fam): A working group met monthly to adapt the CPOT and develop educational material and sample cases for practice scoring until consensus was reached. CPOT‐Fam preclinical testing: Family caregiver study participants viewed educational materials and scored four randomly selected sample cases using the CPOT‐Fam. Scores were compared to reference scores to assess agreement and identify CPOT‐Fam sections requiring revision. Open‐ended feedback on the CPOT‐Fam was collected. CPOT‐Fam revision: the CPOT‐Fam was revised by the working group considering score agreement and feedback received from study participants. Results Of the n = 30 participants, n = 14 (47.0%) had experience with an ICU patient. Agreement between CPOT‐Fam participant scores and reference scores were highest for the vocalization dimension ( Is the patient making any sounds? ; Intraclass correlation coefficient; ICC = 1.0) and lowest for the body movements dimension ( What are the patient's body movements like? ; ICC = 0.85. Participants indicated they found the CPOT‐Fam to be “informative” and “easy‐to‐use” but “not graphic enough”; participants also indicated that descriptors like “lack of breath” and “struggling to move” are helpful with identifying individualistic behaviors of pain exhibited by their loved ones. Conclusion The CPOT‐Fam shows ease of use and may be of value in involving family caregivers in ICU care. Clinical pilot testing is needed to determine feasibility and acceptability and identify further areas for refinement.