The use of next-of-kin to estimate pain in cancer patients

Abstract

The clinical management of pain could be improved if more were known about the intensity and duration of the pain. The cancer patient, however, is often unable to communicate this information to caregivers. Relying on next-of-kin to provide information about the patient's pain could help, but little has been done to verify next-of-kin responses with respect to subjective experiences. For the present study 42 pairs of cancer patients and their next-of-kin were independently surveyed in 1982 in Washington state regarding their cancer pain and various aspects of medical treatment to determine whether proxies can give reliable responses. Close agreement between subject and next-of-kin was observed for the items which were salient and had a limited choice of responses, such as the presence of pain. Agreement in the aggregate was achieved for the items having several possible responses, such as the intensity and frequency of pain. Correspondence was virtually random for those items which had a variety of listed responses. The use of proxies in obtaining information, future research directions, and difficulties with measuring agreement are discussed.

Use of Primary Caretakers as Proxies to Measure the Health Care Needs of Patients with AIDS

“…The designated primary caretaker can provide accurate information on a wide range of items related to environmental and psychosocial support, financial resources, health behaviors, social support, and health management. These results are consistent with those of other studies (Moore, 1988;O'Brien & Francis, 1988;Rogers & Herzog, 1989) that examined the degree of agreement between patients and their proxies on a broad range of health status measures. This study advances our methodological understanding of whether clinicians can access accurate factual and judgmental data on patients' needs when they are mentally and/or physically unable to answer questions.…”

Assessing the pain of people with cognitive impairment

“…Studies have shown that care sta in general hospital settings are not particularly good at identifying their patients' pain (Harrison, 1993;McKinley and Botti, 1991;Zalon, 1993). Family carers of people with cancer, however, are aware if their relative has pain, but cannot tell the extent to which they are in pain (O'Brian and Francis, 1988). It is possible that sta in long-term care settings (where many people with cognitive impairment live) may be better at identifying their patients' pain as they have time to learn individuals' pain behaviours.…”

Assessment of Pain in Cognitively Impaired Older Adults: A Comparison of Pain Assessment Tools and Their Use by Nonprofessional Caregivers

“…Healthcare providers depend on caregivers' reports to assess and manage CI older adults living in community settings. Existing caregiver research points to considerable differences in recognized pain when caregiver assessments are compared with patient self‐reporting of cancer pain 22–24 . Moreover, these studies show that family caregivers report that patients experienced pain more frequently than professional caregivers realize.…”