Family Members’ Experiences with Observing Pain Behaviors Using the Critical-Care Pain Observation Tool

Owen

et al. 2022

Preprint

BackgroundPatients in the intensive care unit (ICU) often have limited ability to communicate making it more difficult to identify and effectively treat their pain. Family caregivers or close friendsof critically ill patients may be able to identifysigns of pain before the clinical care team, and could potentially assist in routine pain assessments. This study will adapt the Critical Care Pain Observation Tool (CPOT) for use by family members to create the CPOT-Fam and compare family CPOT-Fam assessments with nurse-provided CPOT assessments for a given patient.MethodsThis study will be executed in two phases:1) Development of the CPOT-Fam - A working group ofpatient partners, ICU clinicians, and researchers will adapt the CPOT for use by family caregivers (creating the CPOT-Fam) and produce an accompanying educational module to deliver information on pain and how to use the tool.The CPOT-Fam will undergo pre-clinical testing with participants (i.e., members of the public and family caregiversof critically ill adults), who will complete the educational module and provide CPOT-Fam scores on sample cases. Feedback on the CPOT-Fam will be collected.2) Pilot testing the CPOT-Fam – Family caregivers of critically ill adults will complete the educational module and provide information on: 1) demographics, 2) anxiety, 3) caregiving self-efficacy, and 4) satisfaction with care in the ICU. Family caregivers will then provide a proxy assessment of their critically ill loved one’s pain through the CPOT-Fam and also provide a subjective(i.e., questionnaire-based including open-ended responses) accountof their loved one’s pain status. A comparison (i.e., agreement) will be made between family caregiver provided CPOT-Fam scores and ICU nurse-provided CPOT scores (collected from the provincial health information system), calculated independently and blinded to one another. Feasibility and acceptability of the CPOT-Fam will be determined.DiscussionThe results of this work will produce a familycaregiver CPOT (i.e., CPOT-Fam), determine feasibility and acceptability of the CPOT-Fam, and comparepain assessments conducted by family caregivers and ICU nurses. The results will inform whether a larger studyto determine arole for family caregivers in ICU pain assessmentusing the CPOT-Fam is warranted.Trial registration- Not applicable.

Section: Sample Size and Power Considerationsmentioning

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Study Protocol: Development and Pilot Testing of the Critical Care Pain Observation Tool for Families (CPOT-Fam)

Owen

et al. 2022

Preprint

“…In ICU pain assessment, involvement of family caregivers can facilitate earlier pain recognition, reduce anxiety in family, and improve patient and family satisfaction with care [ 26 ]. The CPOT is a validated pain assessment tool for patients unable to self-report pain in ICUs [ 19 ] and may be suitable for use by family caregivers [ 27 ]. The CPOT is a routinely used four-item pain assessment tool with good specificity (78%) and sensitivity (86%), designed to be used by ICU clinicians on ventilated and non-ventilated ICU patients [ 18 , 19 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…CPOT scores have been shown to have a moderate correlation (0.59 and 0.71; p < .05) to self-reported pain intensity of ICU patients during painful procedures in the ICU (such as turning) [ 19 ]. Recent studies suggest that the CPOT may be amenable for use by family caregivers [ 27 , 29 ]. However, some family caregivers have reported that identifying pain behaviors was stressful because they felt discomfort when assessing their loved one’s pain and did not find all elements of the tool relevant [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol: development and pilot testing of the Critical Care Pain Observation Tool for families (CPOT-Fam)

Owen

et al. 2022

Pilot Feasibility Stud

Self Cite

Background Patients in the intensive care unit (ICU) often have limited ability to communicate making it more difficult to identify and effectively treat their pain. Family caregivers or close friends of critically ill patients may be able to identify signs of pain before the clinical care team and could potentially assist in routine pain assessments. This study will adapt the Critical Care Pain Observation Tool (CPOT) for use by family members to create the CPOT-Fam and compare family CPOT-Fam assessments with nurse-provided CPOT assessments for a given patient. Methods This study will be executed in two phases: 1) Development of the CPOT-Fam — A working group of patient partners, ICU clinicians, and researchers will adapt the CPOT for use by family caregivers (creating the CPOT-Fam) and produce an accompanying educational module to deliver information on pain and how to use the tool. The CPOT-Fam will undergo preclinical testing with participants (i.e., members of the public and family caregivers of critically ill adults), who will complete the educational module and provide CPOT-Fam scores on sample cases. Feedback on the CPOT-Fam will be collected. 2) Pilot testing the CPOT — Fam family caregivers of critically ill adults will complete the educational module and provide information on the following: (1) demographics, (2) anxiety, (3) caregiving self-efficacy, and (4) satisfaction with care in the ICU. Family caregivers will then provide a proxy assessment of their critically ill loved one’s pain through the CPOT-Fam and also provide a subjective (i.e., questionnaire-based including open-ended responses) account of their loved one’s pain status. A comparison (i.e., agreement) will be made between family caregiver provided CPOT-Fam scores and ICU nurse-provided CPOT scores (collected from the provincial health information system), calculated independently and blinded to one another. Feasibility and acceptability of the CPOT-Fam will be determined. Discussion The results of this work will produce a family caregiver CPOT (i.e., CPOT-Fam), determine feasibility and acceptability of the CPOT-Fam, and compare pain assessments conducted by family caregivers and ICU nurses. The results will inform whether a larger study to determine a role for family caregivers in ICU pain assessment using the CPOT-Fam is warranted.

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

Longmore

et al. 2022

Health Science Reports

Self Cite

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.