The provision of care is paramount when an individual enters palliative care. Ensuring end-of-life treatment and attention is synonymous with dignity, accuracy, reliability and sensitivity, is all the more important.
Most often when an individual is in palliative care, they are simultaneously experiencing a certain level of pain due to the advanced stages of illness. It, therefore, becomes crucial to be able to assess their pain whilst also providing a safe and sensitive experience for the patient and their family.
Here we discuss the common challenges associated with assessing and measuring pain in palliative care, tools which have been used to assess and measure pain in the past, and how technology is helping to evolve and shape the assessment and measurement of pain in the future.
Challenges of assessing pain in palliative care
Ensuring effective pain management in palliative care is often coupled with how pain is assessed. However, when an individual enters palliative care, they are likely to be living with other, if not multiple, painful conditions.
This presents an assessment challenge for those responsible for their care – because – in more cases than not, the individual is most likely at a point where they are unable to reliably verbalise their own pain.
The task of assessing pain in palliative care becomes challenging as the limitations of manual, paper-based assessment tools are learned – documentation may not occur straight away resulting in recall bias and perhaps too, multiple entries of the same data and thus, double handling.
How pain was measured in the past
Assessment Tools for Palliative Care provides a comprehensive overview of palliative care assessment tools including surveys, scales, and questionnaires and their “application in clinical care, as quality indicators, or for evaluation of interventions.”
Addressed is the pressing fact that paper-based assessment tools were often overwhelming and far too granular so “caregivers felt they could not provide an accurate depiction of their experience and the issues that mattered most to them” because of the copious questions.
Often, caregivers also felt that the way the assessments were administered “always felt rushed” in that they did not have time to reflect on the questions and often just indicated “their initial thoughts” or just “bubbled in an answer.”
Whilst the information captured in the paper-based tools may have been meaningful to clinicians, caregivers were not convinced of the impact on patients or their families.
The outcome of Assessment Tools for Palliative Care found that “few studies of palliative care interventions used the same palliative care assessment tools” and that “future research should focus on the further development of tools; evaluating tools in palliative care populations; and evaluating the responsiveness of tools.”
How technology is assisting with measuring pain
Technological advancements and digitisation are driving the evolution of our industry which has led to the development of digital pain assessment tools such as PainChek. The PainChek app uses artificial intelligence, facial recognition and smartphone technology to scan the face, a proven and easy-to-access determinator for gauging pain, exposing certain micro-facial expressions which are then assessed to indicate, manage and measure the pain levels of that certain individual.
Once the face is automatically assessed, the user is walked through five additional pain indicator domains, these are: movement, behaviour, voice, body and activity. These domains are assessed using binary-based checklists which require the user to indicate whether an indicator of pain is present or absent. Historical paper-based assessment tools would typically ask an assessor to rate (usually from 0-3) how severe a symptom or scenario is. This again opens up a layer of subjectivity which may result in assessor bias and therefore varying outcomes for the resident.
Assessment score responses are documented in real-time on the PainChek app, automating the pain assessment process at the point of care. The outcome then forms the evidence for the implementation of pain management and allows for ongoing monitoring over time.
The PainChek app makes the reliability of recording pain possible for individuals in palliative care who cannot verbalise their own pain, including those with dementia, cognitive impairments, and those unable to self-report.
Whilst manual pain assessment tools require intervention and the inputting of data from clinicians and aged care carers alike, which are often subjective to the person undertaking the assessment, digital assessment tools such as PainChek are enabling best-practice pain management in palliative care by using unbiased domains, such as the face.
At PainChek, accurately assessing and measuring pain underpins the core of what we do. We are proud to provide a tool that offers real-time responses; eliminates the need for manual intervention and administrative duties; is regularly updated and modified when improvements are available; and harnesses technology to assist with assessing pain in palliative care.
If you want to know more about the improvements PainChek can make to your aged care facility, contact us today.
