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.
International Association for the Study of Pain. International Association for the Study of Pain (IASP) Terminology. International Association for the Study of Pain. 2017. https://www.iasp-pain.org/terminology?navItemNumber=576. Accessed December 18, 2018.
PlattM. Pain challenges at the end of life—pain and palliative care collaboration. Rev Pain. 2010;4(2):18–23. doi:10.1177/204946371000400205.
4.
BookerSQHaedtkeC. Assessing pain in nonverbal older adults. Nursing. 2016;46(5):66–69. doi:10.1097/01.nurse.0000480619.08039.50.
5.
TurkDCMatyasTA. Pain-related behaviors communication of pain. APS J. 1992;1(2):109–111. doi:10.1016/1058-9139(92)90038-e.
6.
HsiehJGWangYW. Application of signs of dying identified in traditional Chinese, Tibetan, and modern Western medicine in terminal care. Tzu Chi Med J. 2012;24(1):12–15. doi:10.1016/j.tcmj.2012.02.004.
7.
CadeCH. Clinical tools for the assessment of pain in sedated critically ill adults. Nurs Crit Care. 2008;13(6):288–297. doi:10.1111/j.1478-5153.2008.00294.x.
8.
ChowSChowRLamMet al.Pain assessment tools for older adults with dementia in long-term care facilities: a systematic review. Neurodegener Dis Manag. 2016;6(6):525–538. doi:10.2217/nmt-2016-0033.
9.
LichtnerVDowdingDEsterhuizenPet al.Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatr. 2014;14(1):1–19. doi:10.1186/1471-2318-14-138.
10.
Pudas-TahkaSMAxelinAAantaaRLundVSalanteraS. Pain assessment tools for unconscious or sedated intensive care patients: a systematic review. J Adv Nurs. 2009;65(5):946–956. doi:10.1111/j.1365-2648.2008.04947.x.
11.
McGuireDBKaiserKSHaisfield-WolfeMEIyamuF. Pain assessment in noncommunicative adult palliative care patients. Nurs Clin North Am. 2016;51(3):397–431. doi:10.1016/j.cnur.2016.05.009.
12.
BickelKEMcNiffKBussMKet al.Defining high-quality palliative care in oncology practice: an American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement. J Oncol Pract. 2016;12(9):e828–e838. doi:10.1200/jop.2016.010686.
13.
TerweeCBMokkinkLBKnolDLOsteloRWJGBouterLMVetHCWD. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res. 2011;21(4):651–657. doi:10.1007/s11136-011-9960 -1.
14.
MoherD. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–269. doi:10.7326/0003-4819-151-4-200908180-00135.
15.
HjermstadMJFayersPMHaugenDFet al.Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073–1093. doi:10.1016/j.jpainsymman.2010.08.016.
16.
WardenVHurleyACVolicerL. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4(1):9–15. doi:10.1097/00130535-200301000-00002.
17.
GelinasCJohnstonC. Pain assessment in the critically ill ventilated adult: validation of the critical-care pain observation tool and physiologic indicators. Acute Pain. 2007;9(3):175. doi:10.1016/j.acpain.2007.08.016.
18.
AbbeyJPillerNBellisADet al.The Abbey Pain Scale: a 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004;10(1):6–13. doi:10.12968/ijpn.2004.10.1.12013.
19.
McGuireDBReifsnyderJSoekenKKaiserKSYeagerKA. Assessing pain in nonresponsive hospice patients: development and preliminary testing of the Multidimensional Objective Pain Assessment Tool (MOPAT). J Palliat Med. 2011;14(3):287–292. doi:10.1089/jpm.2010.0302.
20.
Van IerselTTimmermanDMullieA. Introduction of a pain scale for palliative care patients with cognitive impairment. Int J Palliat Nurs. 2006;12(2):54–59. doi:10.12968/ijpn.2006.12.2.20531.
21.
RossMBoitorMGelinasC. Validation of the critical-care pain observation tool with seriously ill patients. J Hosp Palliat Nurs. 2016;18(5):413–420. doi:10.1097/njh.0000000000000266.
22.
CronbachLJ. Essentials of Psychological Testing. Hoboken, NJ: Wiley Blackwell; 2014.
23.
MillerLALovlerRL. Foundations of Psychological Testing: A Practical Approach. Los Angeles, CA: SAGE; 2016.
24.
IrwingPBoothTHughesDJ. The WILEY Handbook of Psychometric Testing: A Multidisciplinary Reference on Survey, Scale and Test Development. Chichester, England: Wiley Blackwell; 2018.
25.
KlineP. Handbook of Psychological Testing. Florence, Italy: Taylor and Francis; 2013.
26.
ApinisCTousignantMArcandMTousignant-LaflammeY. Can adding a standardized observational tool to interdisciplinary evaluation enhance the detection of pain in older adults with cognitive impairments?Pain Med. 2014;15(1):32–41. doi:10.1111/pme.12297.
27.
ArbourCChoiniereMTopolovec-VranicJLoiselleCGGelinasC. Can fluctuations in vital signs be used for pain assessment in critically ill patients with a traumatic brain injury?Pain Res Treat. 2014;2014:1–11. doi:10.1155/2014/175794.
28.
HuiDHessKSantosRDChisholmGBrueraE. A diagnostic model for impending death in cancer patients: preliminary report. Cancer. 2015;121(21):3914–3921. doi:10.1002/cncr.29602.
29.
BarrJKishmanCPJaeschkeR. The methodological approach used to develop the 2013 pain, agitation, and delirium clinical practice guidelines for adult ICU patients. Crit Care Med. 2013;41(9 suppl 1):S1–S15. doi:10.1097/ccm.0b013e3182a167d7.
30.
TappDFrancoeurD. Surveillance optimale de la sédation palliative continue en fin de vie: Le projet SOS (proffered paper). 22th International Congress on Palliative Care. October 2–5 2018, Montreal, Canada.
31.
AslaksonRADySMWilsonRFet al.Patient- and caregiver-reported assessment tools for palliative care: summary of the 2017 agency for healthcare research and quality technical brief. J Pain Symptom Manage. 2017;54(6):961–972. doi:10.1016/j.jpainsymman.2017.04.022.
32.
VriesNJSlootPHAchterbergWP. Pain and pain assessment in stroke patients with aphasia: a systematic review. Aphasiology. 2016;31(6):703–719. doi:10.1080/02687038.2016.1254150.
33.
MckennaHTreanorCO’ReillyDDonnellyM. Evaluation of the psychometric properties of self-reported measures of alcohol consumption: a COSMIN systematic review. Subst Abuse Treat Prev Policy. 2018;13(1). doi:10.1186/s13011-018-0143-8.
