PainChek face analysis

Providing effective, person-centered care at the end of life is paramount in ensuring a person’s life comes to an end with the same dignity with which they’ve lived. Pain is a core focus in this process to ensure a person has the best quality of life during this stage of their care.

With populations aging around the world, an increasing number of people living with dementia are receiving palliative care. This can present a challenge for the health and care sectors, as ensuring effective pain management can become more difficult to achieve as a person’s ability to self-report their pain declines.

Challenges of pain assessment in palliative care

In the case of dementia, ensuring effective pain management presents a significant challenge to those working in the health and care fields. In addition to dementia, these individuals are likely to be living with other conditions that are painful, such as osteoarthritis, injuries from falls, UTIs and cancers. At the stage of palliative care, a person’s dementia is also likely to be advanced to the point where their ability to reliably self-report their pain may be extremely limited. Therefore, it’s important to ensure other tools are in place to help nurses and clinicians identify and quantify that pain for the recipient of care.

There are a number of manual paper-based pain assessment tools that have been developed over the years to address these challenges. Whilst these tools do provide a framework for assessing pain for people who cannot self-report, they are typically underused, particularly in aged care.

There are a number of reasons for this. Firstly, paper-based pain assessments are often perceived as redundant by staff. Carers working to time pressures may feel that their long-term knowledge of a resident and their health history is an adequate basis upon which to form pain management decisions.

In addition, manual pain assessment tools can be subjective. They rely on the caregiver to rate the severity of patients’ symptoms. Regardless of a carer or clinicians professionalism and experience, opinions often vary significantly between different assessors. This results in varying pain management outcomes.

Paper based tools are also cumbersome and often rely on a degree of manual handling of data and often double entry of data if the care provider uses both a paper based assessment and digital care management system.

Quality of life

During the palliative care stage, managing pain can be one of the most impactful ways of improving someone’s quality of life during their final stages of life to ensure they are as comfortable as possible. As recommended by the Australian Pain Society, the first step towards managing pain must begin with a full & thorough assessment of the person’s pain. The first step would always be to ask a person if they’re in pain and if they were, to rate it on a scale of 0-10. This remains the gold-standard for pain assessment, however for many people receiving palliative care, this is not possible due to dementia, or other cognitive impairment. As discussed above, paper-based tools still leave much to be desired when it comes to identifying and quantifying pain for people living with dementia. So what are the best tools available to accurately assess pain for those who cannot reliably self-report?

PainChek’s AI driven assessment tool takes an objective approach to pain assessment. It assesses pain over 6 domains:

    • Face
    • Voice
    • Body
    • Movement
    • Activity
    • Behaviour

Of the 6 domains, the face is the most challenging to assess manually and requires a high degree of pain knowledge and training. To combat this, PainChek has utilised the power of Artificial Intelligence (AI) and facial analysis through a smart devices camera to objectively assess the face and identify 9 micro-facial expressions indicative of pain.

Once the face has been assessed, users are then talked through the following 5 domains which operate on a binary checklist in which they mark whether certain indicators of pain are either present or absent. This present/absent approach removes the subjective rating process utilised by more traditional paper-based methods.

As a result PainChek has been clinically validated and has medical device clearance in Australia, New Zealand, Singapore, Europe, the United Kingdom and Canada.

Involving family in the care of their loved one

Ensuring family and loved ones are kept well informed on their relatives care and wellbeing is hugely important across all elements of care, but none more so than during the palliative care stage. Thanks to increasingly available digital systems, the ability to share vital information regarding a loved one with their family is becoming more easy. Not only can digital systems therefore deliver consistent and reliable results, they can support the family of a recipient of care by giving them the knowledge and comfort that their loved one is pain free during the palliative care stage.

The ability to gain access to pain management is becoming more widely recognised as a human right. Therefore a growing emphasis on demonstrating how this is being achieved is gaining momentum amongst care providers. Without effective pain assessments, pain can never be properly managed.

Effective, digitally-led pain assessment can therefore ensure a person is as comfortable as possible, the assessment process and required interventions are appropriately recorded, follow up assessments happen quickly to ensure the intervention had the desired effect, and also improve the documentation of the pain assessment and management process to satisfy both the family as well as regulator.

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