A direct observation of pain scale use in five video-recorded palliative care consultations

Using conversation analysis to show how practitioners support patients to describe pain

Abstract

Objective

Assessing pain intensity is an important palliative care task. Self-report pain intensity scales are frequently used within assessment. In contrast to formal studies of validity and reliability, we examine administration of, and responses to these scales in everyday palliative care.

Methods

We searched episodes of pain scale use in a dataset of (video/audio-recorded) UK palliative care consultations involving five doctors, 37 terminally ill patients and their companions. We found five, and applied the techniques and tools of conversation analysis to characterise scales’ administration and functioning.

Results

Generally, the patients responded to scales by reporting multiple aspects of pain; the doctors supported and encouraged this. In two episodes, the scales generated misunderstandings. The doctors worked to resolve these in ways that avoided implying the patient was at fault.

Conclusion

Pain intensity scales can yield richer information than just intensity. They can also generate misunderstandings and social friction which take skill and effort to resolve.

Citation

Laura Jenkins , Ruth Perry Christina Faull .  Assinging the importnace to  pain in palative care tasks.  Published online  in Patience Education and councilling.   25 Oct 2021.  doi.org/10.1016/j.pec.2021.10.027