Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice

Background: Assessing pain in infants, children and young people with life-limiting conditions remains a challenge due to diverse patient conditions, types of pain and often a reduced ability or inability of patients to communicate verbally. Aim: To systematically identify pain assessment tools that are currently used in paediatric palliative care and examine their psychometric properties and feasibility and make recommendations for clinical practice. Design: A systematic literature review and evaluation of psychometric properties of pain assessment tools of original peer-reviewed research published from inception of data sources to April 2021. Data sources: PsycINFO via ProQuest, Web of Science Core, Medline via Ovid, EMBASE, BIOSIS and CINAHL were searched from inception to April 2021. Hand searches of reference lists of included studies and relevant reviews were performed. Results: From 1168 articles identified, 201 papers were selected for full-text assessment. Thirty-four articles met the eligibility criteria and we examined the psychometric properties of 22 pain assessment tools. Overall, the Faces Pain Scale-Revised (FPS-R) had high cross-cultural validity, construct validity (hypothesis testing) and responsiveness; while the Faces, Legs, Activity, Cry and Consolability (FLACC) scale and Paediatric Pain Profile (PPP) had high internal consistency, criterion validity, reliability and responsiveness. The number of studies per psychometric property of each pain assessment tool was limited and the methodological quality of included studies was low. Conclusion: Balancing aspects of feasibility and psychometric properties, the FPS-R is recommended for self-assessment, and the FLACC scale/FLACC Revised and PPP are the recommended observational tools in their respective age groups.

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Self-efficacy assessment tools for individuals with depression: protocol for a systematic review of the literature

BMJ Open ◽

10.1136/bmjopen-2018-021895 ◽

2019 ◽

Vol 9 (6) ◽

pp. e021895

Author(s):

Marina Araújo Rosas ◽

Tattiana Dias de Carvalho Cordeiro ◽

Tatiana de Paula Santana da Silva ◽

Ada Salvetti Cavalcanti Caldas ◽

Carlos Eduardo de Souza Leão Ribeiro ◽

...

Keyword(s):

Systematic Review ◽

Psychometric Properties ◽

Mood Disorders ◽

Self Efficacy ◽

Meta Analysis ◽

Age Groups ◽

Well Being ◽

Assessment Tools ◽

Eligibility Criteria ◽

The Impact

IntroductionDepression is a common debilitating disease that affects individuals in all age groups. The impact of the diagnosis extends beyond the individual, with negative effects on mental health, physical health and social well-being. Self-efficacy has been referenced as an important aspect to the prognosis of mood disorders by conferring co-responsibility to the affected individual to face his/her health problems. Several assessment tools are found in the literature for measuring self-efficacy, but it is not yet clear which of these measures are more applicable to individuals with mood disorders, particularly depression. Thus, the aim of present study is to propose a systematic review to examine the psychometric properties and applicability of assessment tools designed to measure self-efficacy in individuals with symptoms and/or a diagnosis of depression.Methods and analysisThis protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and the review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The evaluation of the psychometric properties of the health outcome measures will be conducted according to COSMIN guidelines. Two independent reviewers will perform the electronic searches in the PubMed, Web of Science, PsycInfo, SCOPUS and CINAHL databases, followed by the use of the ‘snowball’ strategy. The inclusion criteria will be (1) instrument validation studies, (2) developed with individuals of any age (3) with symptoms or a diagnosis of depression. Two independent reviewers will analyse the titles and abstracts of the articles retrieved during the search for pre-selection, followed by full-text analyses to determine inclusion in the review based on the eligibility criteria. Cases of a divergence of opinion will be resolved by a third reviewer. Descriptive analysis of the articles will be performed (data on participants, characteristics, psychometric properties and clinical usefulness of the assessment tools).Ethics and disseminationThe proposed systematic review will provide information on assessment tools employed to measure self-efficacy with regard to coping with depression, offering data on the psychometric properties, strong and weak points, and clinical applicability. As a secondary analysis of the literature, the approval of an ethics committee is not required.PROSPERO registration numberCRD42017078707

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Prospective Study Evaluating a Pain Assessment Tool in a Postoperative Environment: Protocol for Algorithm Testing and Enhancement (Preprint)

10.2196/preprints.17783 ◽

2020 ◽

Author(s):

Emad Kasaeyan Naeini ◽

Mingzhe Jiang ◽

Elise Syrjälä ◽

Michael-David Calderon ◽

Riitta Mieronkoski ◽

...

Keyword(s):

Electrical Activity ◽

Pain Assessment ◽

Assessment Tool ◽

Elective Surgery ◽

Electrodermal Activity ◽

Vital Signs ◽

Assessment Tools ◽

Second Phase ◽

Moderate Pain ◽

Management Interventions

BACKGROUND Assessment of pain is critical to its optimal treatment. There is a high demand for accurate objective pain assessment for effectively optimizing pain management interventions. However, pain is a multivalent, dynamic, and ambiguous phenomenon that is difficult to quantify, particularly when the patient’s ability to communicate is limited. The criterion standard of pain intensity assessment is self-reporting. However, this unidimensional model is disparaged for its oversimplification and limited applicability in several vulnerable patient populations. Researchers have attempted to develop objective pain assessment tools through analysis of physiological pain indicators, such as electrocardiography, electromyography, photoplethysmography, and electrodermal activity. However, pain assessment by using only these signals can be unreliable, as various other factors alter these vital signs and the adaptation of vital signs to pain stimulation varies from person to person. Objective pain assessment using behavioral signs such as facial expressions has recently gained attention. OBJECTIVE Our objective is to further the development and research of a pain assessment tool for use with patients who are likely experiencing mild to moderate pain. We will collect observational data through wearable technologies, measuring facial electromyography, electrocardiography, photoplethysmography, and electrodermal activity. METHODS This protocol focuses on the second phase of a larger study of multimodal signal acquisition through facial muscle electrical activity, cardiac electrical activity, and electrodermal activity as indicators of pain and for building predictive models. We used state-of-the-art standard sensors to measure bioelectrical electromyographic signals and changes in heart rate, respiratory rate, and oxygen saturation. Based on the results, we further developed the pain assessment tool and reconstituted it with modern wearable sensors, devices, and algorithms. In this second phase, we will test the smart pain assessment tool in communicative patients after elective surgery in the recovery room. RESULTS Our human research protections application for institutional review board review was approved for this part of the study. We expect to have the pain assessment tool developed and available for further research in early 2021. Preliminary results will be ready for publication during fall 2020. CONCLUSIONS This study will help to further the development of and research on an objective pain assessment tool for monitoring patients likely experiencing mild to moderate pain. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17783

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Development of a spiritual pain assessment sheet for terminal cancer patients: Targeting terminal cancer patients admitted to palliative care units in Japan

Palliative & Supportive Care ◽

10.1017/s147895150606024x ◽

2006 ◽

Vol 4 (2) ◽

pp. 179-188 ◽

Cited By ~ 5

Author(s):

KEIKO TAMURA ◽

KAORI ICHIHARA ◽

EIKO MAETAKI ◽

KEIKO TAKAYAMA ◽

KUMI TANISAWA ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Pain Assessment ◽

Assessment Tool ◽

Three Dimensions ◽

Terminal Cancer ◽

Philosophical Perspective ◽

Terminal Cancer Patients ◽

Assessment Sheet ◽

Palliative Care Units

Objective: This research explores the potential benefit of a spiritual pain assessment sheet to clinical practice. With spiritual pain defined as “pain caused by extinction of the being and meaning of the self,” the spiritual pain assessment sheet was developed by Hisayuki Murata from his conceptual framework reflecting the three dimensions of a human being as a being founded on temporality, a being in relationship, and a being with autonomy. The assessment sheet was developed from reviews of the literature and examinations from a philosophical perspective on the structure of spiritual pain.Methods: Patients admitted to palliative care units in Japan were interviewed using the assessment sheet. The responses were analyzed qualitatively. The usefulness of the assessment sheet and the burden placed on the patients by its use were also investigated.Results: The spiritual pain elucidated by the assessment sheet was the same as that revealed in the earlier research of Morita. The patients reported that they did not find the use of the assessment sheet a burden, and more than half reported that it was useful. The burden of the assessment sheet on the subjects was thus determined to be low. Positive feedback on the assessment sheet was also received from the nurses who conducted the patient interviews, who said the assessment sheet made it easier to talk with the patients about their spiritual pain.Significance of research: The research results indicate that the spiritual pain assessment sheet provided an appropriate assessment of spiritual pain among terminal cancer patients, showing that such a sheet could be used as an assessment tool in the future.

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European Palliative Care Research Center Collaborative Pain Assessment Tool

PsycTESTS Dataset ◽

10.1037/t12128-000 ◽

2011 ◽

Author(s):

Peter M. Fayers ◽

◽

Marianne J. Hjermstad ◽

Pål Klepstad ◽

Jon Håvard Loge ◽

...

Keyword(s):

Palliative Care ◽

Pain Assessment ◽

Assessment Tool ◽

Research Center ◽

Care Research

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Managing delirium in terminally ill patients: perspective of palliative care nurse specialists

British Journal of Community Nursing ◽

10.12968/bjcn.2020.25.7.346 ◽

2020 ◽

Vol 25 (7) ◽

pp. 346-352

Author(s):

Clare Harris ◽

Juliet Spiller ◽

Anne Finucane

Keyword(s):

Palliative Care ◽

Assessment Tool ◽

Further Education ◽

Assessment Tools ◽

Clinical Nurse Specialists ◽

Framework Approach ◽

Delirium Prevention ◽

Delirium Management ◽

Management Approaches ◽

Routine Assessment

Delirium occurs frequently at end of life. Palliative care clinical nurse specialists (CNSs) are involved in community palliative care provision. Many patients prefer being cared for at home, yet managing delirium in this setting presents unique challenges, potentially resulting in emergency hospital or hospice admission. We examined the experiences and practice of palliative care CNSs managing delirium in the community; 10 interviews were undertaken. Data were analysed using the framework approach. Challenges to delirium management in the community included limited time with patients, reliance on families and access to medications. Assessment tools were not used routinely; time limited visits and inconsistent retesting were perceived barriers. Management approaches differed depending on CNSs' previous delirium education. Strategies to prevent delirium were not used. Community delirium management presents challenges; support surrounding these could be beneficial. Routine assessment tool use and delirium prevention strategies should be included in further education and research.

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

Journal of Palliative Care ◽

10.1177/0825859718816073 ◽

2019 ◽

Vol 34 (4) ◽

pp. 255-266 ◽

Cited By ~ 5

Author(s):

Diane Tapp ◽

Sara Chenacher ◽

Ngangue Patrice Alain Gérard ◽

Philippe Bérubé-Mercier ◽

Celine Gelinas ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Pain Assessment ◽

Reliability And Validity ◽

Assessment Tools ◽

Cochrane Library ◽

Severe Illness ◽

Assessment Instruments ◽

Measurement Instruments ◽

Health Measurement

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.

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Assessment tools for palliative care.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.66 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 66-66

Author(s):

Sarina Isenberg ◽

Rebecca Aslakson ◽

Sydney Morss Dy ◽

Renee Wilson ◽

Julie Waldfogel ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Clinical Practice ◽

Quality Indicators ◽

Systematic Reviews ◽

Grey Literature ◽

Care Quality ◽

Assessment Tools ◽

Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

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Health-related quality-of-life outcome measures in paediatric palliative care: A systematic review of psychometric properties and feasibility of use

Palliative Medicine ◽

10.1177/0269216316649155 ◽

2016 ◽

Vol 30 (10) ◽

pp. 935-949 ◽

Cited By ~ 20

Author(s):

Lucy H Coombes ◽

Theresa Wiseman ◽

Grace Lucas ◽

Amrit Sangha ◽

Fliss EM Murtagh

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Psychometric Properties ◽

Outcome Measures ◽

Health Related Quality ◽

Paediatric Palliative Care ◽

Quality Of Life Measures ◽

Related Quality ◽

Health Related

Background: The number of children worldwide requiring palliative care services is increasing due to advances in medical care and technology. The use of outcome measures is important to improve the quality and effectiveness of care. Aim: To systematically identify health-related quality-of-life outcome measures that could be used in paediatric palliative care and examine their feasibility of use and psychometric properties. Design: A systematic literature review and analysis of psychometric properties. Data sources: PsychInfo, Medline and EMBASE were searched from 1 January 1990 to 10 December 2014. Hand searches of the reference list of included studies and relevant reviews were also performed. Results: From 3460 articles, 125 papers were selected for full-text assessment. A total of 41 articles met the eligibility criteria and examined the psychometric properties of 22 health-related quality-of-life measures. Evidence was limited as at least half of the information on psychometric properties per instrument was missing. Measurement error was not analysed in any of the included articles and responsiveness was only analysed in one study. The methodological quality of included studies varied greatly. Conclusion: There is currently no ‘ideal’ outcome assessment measure for use in paediatric palliative care. The domains of generic health-related quality-of-life measures are not relevant to all children receiving palliative care and some domains within disease-specific measures are only relevant for that specific population. Potential solutions include adapting an existing measure or developing more individualized patient-centred outcome and experience measures. Either way, it is important to continue work on outcome measurement in this field.

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Assessment of paediatric pain: a critical review

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2015-0041 ◽

2016 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Sachin Manocha ◽

Navneet Taneja

Keyword(s):

Pain Assessment ◽

Psychological Factors ◽

Age Groups ◽

Assessment Tools ◽

Measurement Tool ◽

Cognitive Level ◽

Pubmed Search ◽

Paediatric Age ◽

In Infants And Children ◽

Selection Of

AbstractPain is a complex experience, and its quantification involves many aspects including physiological, behavioural, and psychological factors. References related to the topic were selected and analysed, along with a PubMed search of the recent and earlier reports. Assessment of pain in infants and children has always been a dilemma for the clinicians. Unlike in adults, it is difficult to assess and effectively treat pain in paediatric age groups, and it often remains untreated or undertreated. Misperceptions are attributed not only to the difficulties in isolating the specific signs of pain but also in recognising and inferring the meaning of the cues available in the complex of individual differences in the reaction pattern of children to pain. In children, several parameters such as age, cognitive level, type of pain, etc. are required to be considered for the selection of appropriate pain assessment tools. Although considerable progress has been made, there is a critical need for a more accurate measurement tool for both research and clinical purposes. This review has critically analysed the various techniques available to assess pain in children with emphasis on current research and present-day status of paediatric pain assessment.

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