Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review

Abstract

Purpose: To review studies pertaining to the reliability and validity of observational pain assessment tools for use with nonverbal patients at the end-of-life, a field of research not documented by previous systematic reviews. Methods: Databases (PubMed, Embase, Epistemonikos, the Cochrane Library, and CINAHL) were systematically searched for studies from study inception to February 21, 2016 (update in May 9, 2018). Two independent reviewers screened study titles, abstracts, and full texts according to inclusion and exclusion criteria. Disagreements were resolved through consensus. Reviewers also extracted the psychometrics properties of studies of observational pain assessment instruments dedicated to a noncommunicative population in palliative care or at the end-of-life. A comprehensive quality assessment was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to derive poor, fair, good or excellent ratings for the psychometric tests reported in each study. Results: Four studies linked to 4 different tools met the inclusion criteria. Study populations included dementia, palliative care and severe illness in the context of intensive care. All the studies included in this review obtained poor COSMIN ratings overall. Conclusions: At this point, it is impossible to recommend any of the tools evaluated given the low number and quality of the studies. Other analyses and studies need to be conducted to develop, adapt, or further validate observational pain instruments for the end-of-life population, regardless of the disease.

Burns pain management: The role of nurse–patient communication

“…Similar to this finding, Tapp et al, [33] reported that due to the subjective nature of pain, its assessment and management can only be attained when there is effective communication between patients and health care providers. Specifically, effective communication between nurses and patients can result in more effective pain management [34].…”

Pain assessment and interventions by nurses in the emergency department: A national survey

“…Of the pain assessment instruments identified, the Critical Care Pain Observation Tool and Behavioural Pain Scale have both been extensively validated in critically ill intubated adult patients (Stites, 2013; Tapp et al, 2019; Varndell, Fry, & Elliott, 2016), yet were infrequently (26.5%) used. While adequate pain relief in the ED is paramount to optimising patient comfort, critically ill patients frequently experience moderate‐to‐severe pain whilst intubated and mechanically ventilated that is often under‐recognised and under‐treated (Batiha, 2014; Clukey, Weyant, Roberts, & Henderson, 2014; Thomas, 2013).…”

Assessment of pain in people living with dementia at the end of life: a systematic review

“…With respect to their psychometric properties Goebel et al (2019) found PAINAD to be a reliable and valid tool for pain screening in medical or surgical settings. However, a recent systematic review (Tapp et al 2019) assessing pain assessment tools for non-verbal patients at EoL concluded that more work is needed to improve the scientific basis for testing and recommended a new tool be developed for this population. The EPCA assessment scale was assessed by Morello et al (2007) was found to have good psychometric properties and was included in a 2016 systematic review (Husebo et al 2016).…”