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Assessment of discomfort in patients with cognitive failure in palliative care*

Published online by Cambridge University Press:  03 August 2015

José António Ferraz Gonçalves Open the ORCID record for José António Ferraz Gonçalves [Opens in a new window] ,
Elisabete Costa ,
Natércia Edra ,
João Gil ,
Carla Martinho ,
Emília Neves ,
Vânia Peixoto ,
Andreia Rodrigues ,
Margarida Silva  and
Sara Teixeira
José António Ferraz Gonçalves*
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Elisabete Costa
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Natércia Edra
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
João Gil
Affiliation:
Hospital de Matosinhos, Matosinhos, Portugal
Carla Martinho
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Emília Neves
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Vânia Peixoto
Affiliation:
Hospital de Santa Maria da Feira, Santa Maria da Feira, Portugal
Andreia Rodrigues
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Margarida Silva
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Sara Teixeira
Affiliation:
Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
*
Address correspondence and reprint requests to José António Ferraz Gonçalves, Palliative Care Service, Portuguese Institute of Oncology, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal. E-Mail: ferrazg@netcabo.pt or ferrazg@ipoporto.min-saude.pt.
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Abstract

Objective:

When cognitive impairment precludes patients' report of symptoms, it becomes necessary to use other means. The purpose of our study was to evaluate the validity of the method currently in use on our service.

Method:

Two members of the team simultaneously assessed the patient and independently recorded whether the patient showed signs of discomfort, and a third questioned patients with cognitive failure who maintained some ability to respond if something was bothering them.

Results:

Some 200 assessments were made of 116 patients. The kappa coefficient of agreement was 0.615. The sensitivity was 17% and specificity 99%. The positive predictive value was 88%, and the negative predictive value was 73%.

Significance of Results:

Due to the low sensitivity of this method, it cannot be recommended as a screening tool.

Keywords

Palliative careCognitive FailureAssessment toolsDiscomfort assessment
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 3 , June 2016 , pp. 278 - 283
Copyright
Copyright © Cambridge University Press 2015 

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Footnotes

*

Adapted from: Inouye et al. (1990). © Copyright 2003, Sharon K. Inouye, M.D., M/P/H.

References

REFERENCES

Altman, D.G. (1991). Practical statistics for medical research. London: Chapman and Hall.Google Scholar
Aminoff, B.Z., Purits, E., Noy, S., et al. (2004). Measuring the suffering of end-stage dementia: Reliability and validity of the Mini-Suffering State Examination. Archives of Gerontology and Geriatrics, 38, 123–130.Google Scholar
Arif-Rahu, M. & Grap, M.J. (2010). Facial expression and pain in the critically ill non-communicative patient: State of science review. Intensive and Critical Care Nursing, 26, 343–352.Google Scholar
Campbell, M.L., Templim, T. & Walch, J. (2010). A respiratory distress observation scale for patients unable to self-report dyspnoea. Journal of Palliative Medicine, 13, 285–290.CrossRefGoogle Scholar
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.Google Scholar
Cohen-Mansfield, J. (2002). Relatives' assessment of pain in cognitively impaired nursing home residents. Journal of Pain and Symptom Management, 24, 562–571.Google Scholar
Ettema, T.P., Dröes, R.M., de Lange, J., et al. (2005). A review of quality of life instruments used in dementia. Quality of Life Research, 14, 675–686.CrossRefGoogle ScholarPubMed
Fuchs-Lacelle, S. & Hadjistavropoulos, T. (2004). Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Management Nursing, 5, 37–49.Google Scholar
Glare, P., Virik, K., Jones, M., et al. (2003). A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ, 327, 95–198.Google Scholar
Gélinas, C., Fillion, L., Puntillo, K., et al. (2006). Validation of the Critical Care Pain Observation Tool in adult patients. American Journal of Critical Care, 15, 420–427.Google Scholar
Gélinas, C., Harel, F., Fillion, L., et al. (2009). Sensitivity and specificity of the Critical Care Pain Observation Tool for the detection of pain in intubated adults after cardiac surgery. Journal of Pain and Symptom Management, 37, 58–67.CrossRefGoogle ScholarPubMed
Gonçalves, F., Bento, M.J., Alvarenga, M., et al. (2008). Validation of a consciousness level scale for palliative care. Palliative Medicine, 22, 724–729.CrossRefGoogle ScholarPubMed
Herr, K., Bjoro, K. & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain and Symptom Management, 31, 170–192.Google Scholar
Hølen, J.C., Saltvedt, I., Fayers, P.M., et al. (2007). Doloplus-2, a valid tool for behavioural pain assessment? BMC Geriatrics, 7, 29.CrossRefGoogle ScholarPubMed
Horgas, A. & Miller, L. (2008). Pain assessment in people with dementia. The American Journal of Nursing, 108, 62–70.Google Scholar
Inouye, S.K., van Dick, C.H., Alessi, C.A., et al. (1990). Clarifying confusion: The confusion assessment method. Annals of Internal Medicine, 113, 941–948.CrossRefGoogle ScholarPubMed
Jordan, A., Hughes, J., Pakresi, M., et al. (2011). The utility of PAINAD in assessing pain in a UK population with severe dementia. International Journal of Geriatric Psychiatry, 26, 118–126.Google Scholar
Kasper, J.D., Black, B.S., Shore, A.D., et al. (2009). Evaluation of the validity and reliability of the Alzheimer Disease-Related Quality of Life Assessment Instrument. Alzheimer Disease and Associated Disorders, 23, 275–284.CrossRefGoogle ScholarPubMed
Kovach, C.R., Noonan, P.E., Griffie, J., et al. (2001). Use of the assessment of discomfort in dementia protocol. Applied Nursing Research, 14, 193–200.CrossRefGoogle ScholarPubMed
Kovach, C.R., Noonan, P.E., Griffie, J., et al. (2002). The assessment of discomfort in dementia protocol. Pain Management Nursing, 3, 16–27.CrossRefGoogle ScholarPubMed
Labus, J., Keefe, F. & Jensen, M. (2003). Self-reports of pain intensity and direct observations of pain behaviour: When are they correlated? Journal of Pain, 102, 109–124.Google Scholar
Li, D., Puntillo, K. & Miaskowski, C. (2008). A review of objective pain measures for use with critical care adult patients unable to self-report. Journal of Pain, 9, 2–10.Google Scholar
Logsdon, R.G., Gibbons, L.E., McCurry, S.M., et al. (1999). Quality of life in Alzheimer disease: Patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–31.Google Scholar
Lotan, M., Ljunggren, E.A., Johnsen, T.B., et al. (2009). A modified version of the Non-Communicating Children Pain Checklist–Revised, adapted to adults with intellectual and developmental disabilities: Sensitivity to pain and internal consistency. Journal of Pain, 10, 398–407.CrossRefGoogle ScholarPubMed
Manfredi, P.L., Breuer, B., Meier, D.E., et al. (2003). Pain assessment in elderly patients with severe dementia. Journal of Pain and Symptom Management, 25, 48–52.Google Scholar
Martin-Cook, K., Hynan, L.S., Rice-Koch, K., et al. (2005). Responsiveness of the Quality of Life in Late-Stage Dementia Scale to psychotropic drug treatment in late-stage dementia. Dementia and Geriatric Cognitive Disorders, 19, 82–85.CrossRefGoogle ScholarPubMed
Mateo, O. & Krenzischek, D. (1992). A pilot study to assess the relationship between behavioural manifestations and self-report of pain in post-anaesthesia care unit patients. Journal of Post Anesthesia Nursing, 7, 15–21.Google Scholar
Moroni, M., Zocchi, D., Bolognesi, D., et al. (2014). The “surprise” question in advanced cancer patients: A prospective study among general practitioners. Palliative Medicine, 28, 959–964.Google Scholar
Morrelo, R., Jean, A., Alix, M., et al. (2007). A scale to measure pain in non-verbally communicating older patients: The EPCA-2 study of its psychometrics properties. Pain, 133, 87–98.Google Scholar
NICE Clinical Guideline 42 (2006). Supporting people with dementia and their carers in health and social care. Available from guidance.nice.org.uk/cg42.Google Scholar
Odhner, M., Wegman, D., Freeland, N., et al. (2003). Assessing pain control in nonverbal critically ill adults. Dimensions of Critical Care Nursing, 22, 260–267.CrossRefGoogle ScholarPubMed
Payen, J., Bru, O., Bosson, J., et al. (2001). Assessing pain in critically ill sedated patients by using a behavioral pain scale. Critical Care Medicine, 29, 2258–2263.Google Scholar
Puntillo, K., Miaskowski, C., Kehrle, K., et al. (1997). Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration. Critical Care Medicine, 25, 1159–1166.Google Scholar
Puntillo, K., Morris, A., Thompson, C., et al. (2004). Pain behaviors observed during six common procedures: Result from Thunder Project II. Critical Care Medicine, 32, 421–427.Google Scholar
Regnard, C., Reynolds, J., Watson, B., et al. (2007). Understanding distress in people with severe communication difficulties: Developing and assessing the disability distress assessment tool (DisDAT). Journal of Intellectual Disability Research, 51, 277–292.Google Scholar
Shuster, J.L. (1998). Delirium, confusion, and agitation at the end of life. Journal of Palliative Medicine, 1, 177–186.Google Scholar
Volicer, L., Hurley, A.C. & Blasi, Z.V. (2001). Scales for evaluation of end-of-life care in dementia. Alzheimer Disease and Associated Disorders, 15, 194–200.Google Scholar
Wary, B. & Collectif Doloplus (1999): Doloplus-2, une échelle pour évaluer la douleur. Soins Gérontologie, 19, 25–27.Google Scholar
Zwakhalen, S.M., Hamers, J.P., Abu-Saad, H.H., et al. (2006). Pain in elderly people with severe dementia: A systematic review of behavioral pain assessment tools. BMC Geriatrics, 6, 1.Google Scholar