Under-diagnosis of pain by primary physicians and late referral to a palliative care team Full Text
BMC Palliative Care, 06/11/2012
Akashi M et al. – Under–diagnosis of pain by primary physicians was associated with late referral to palliative care teams (PCTs). Shortening the duration from admission to referral to PCTs, and increasing physicians' awareness of palliative care may improve pain management for cancer patients.Methods
- This retrospective study was performed in the Teikyo University teaching–hospital for a period of 20 months.
- Authors investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians.
- The outcome of the present study was the under–diagnosis of pain by primary physicians with routinely self–completed standard format checklists.
- The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation.
- Under–diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only.
- Late referral to PCTs after admission was defined as a referral to the PCT at [greater than or equal to]20 days after admission.
- Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, authors used 20 days as the cut–off point for "late referral."
- Accurate pain assessment was observed in 192 triads, whereas 21 triads displayed under–diagnosis of pain by primary physicians.
- Under–diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25 days versus 4 days, p < 0.0001).
- After adjusting for potential confounding factors, under–diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27 6.71).
- Other factors significantly associated with underdiagnosis of pain were coexisting delirium and case management by physicians with < 6 years of clinical experience.