Communicating Pain Assessment Effectively

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1 ASCO International Palliative Care Course Jakarta, March 08 10, 2017 Communicating Pain Assessment Effectively Janet Abrahm, MD, FAAHPM, FACP Palliative Care Interdisciplinary Curriculum

2 Pain assessment Objectives Listening Model to guide symptom assessment Communicating effectively PAINAD

3 Imagine

4 How will you feel if I don t ask about your concerns?

5 Listening Exercise Pairs 1, 2 Speaker, listener Speaker describe a significant event in your life Person, pet, object, etc 3 minutes Listener silent

6 Group debrief The biggest communication problem We do not listen to understand We listen to reply

7 Pain assessment is a model for symptom assessment...

8 Video Hector 67 year old male Colon cancer Bone metastases Listen for important elements of the pain assessment...

9

10 Video Debrief What were the important elements of the pain assessment...

11 Pain Assessment 1. Location 2. Description ( type ) 3. Change over time 4. Severity ( 0 10 ) 5. Effect of treatments Benefit ( + ) Side effects ( - )

12 Where is it? Does it move? 1. Location

13 2. Description What does the pain feel like? Does it ever feel burning or shooting? How does the pain impact your life?

14 Nociceptive Pain Somatic pain Described as... Skin, soft tissue, bone Easy to describe, localize Visceral pain Organs Difficult to describe, localize Sharp Aching Throbbing Wolf CJ. Ann Intern Med

15 Neuropathic Pain Described as Burning Electrical Shooting Stabbing Tingling Associated numbness Pain may be > observable injury Wolf CJ. Ann Intern Med

16 3. Change over time Constant Breakthrough Intermittent acute

17 4. Pain Severity = 5th Vital Sign 17

18 5. Effect of treatments Medications, therapies tried What worked? What didn t work? Any effects you didn t like?

19 Pain Assessment Psychological social spiritual concerns Anxiety, depression Family or other social stresses, burdens Meaning and value, Why me? Behavioral changes Activities, mood

20 General exam Focused exam Examination Guarding? Pain with motion? Masses, tenderness? Psychological exam Anxious, withdrawn, depressed?

21

22 Communicating pain assessment effectively

23 Communication The wrong way The right way

24 Communication Exercise Pairs 1, 2 Same case study Clinician 1 give report Clinician 2 receive report, listen

25 Communicating Assessment Brief description of the patient 1. Location 2. Description ( type ) 3. Change over time 4. Severity ( 0 10 ) 5. Effect of treatments Benefit ( + ) Side effects ( - )

26 Repeat Communication Exercise Same pairs 1, 2 Same case study Clinician 2 give report Clinician 1 receive report, listen

27 Communicating Assessment Brief description of the patient 1. Location: Leg 2. Description ( type ): Dull 3. Change over time: no 4. Severity ( 0 10 ): Average 3, Worst 4 5. Effect of treatments: Meds, cream Benefit ( + ) Side effects ( - )

28 Group Discussion Is structure helpful? Take-home messages?

29 Pain assessment in the cognitively impaired

30 Warden V, Hurley AC, Volicer V. J Am Med Dir Assoc, 2003; 4 :9-15.

31 Other Symptom Assessment 1. Location 2. Description ( type ) 3. Change over time 4. Severity ( 0 10 ) 5. Effect of treatments Benefit ( + ) Side effects ( - )

32 Summary Listen Assess Communicate effectively Pain is a model for symptom assessment and communication...

33 Gandhi You need to be the change you want to see in the world Kobacker House Columbus, Ohio ASCO International Palliative Care Course Jakarta, March 08 10, 2017

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