Grossman S A, Sheidler V R, Swedeen K, Mucenski J, Piantadosi S
J Pain Symptom Manage. 1991 Feb;6(2):53-7. doi: 10.1016/0885-3924(91)90518-9.
Undertreatment of cancer pain is widely recognized. This study sought to determine if inadequate communication about pain intensity between health care providers and their patients could represent a significant factor interfering with the control of cancer pain. One hundred and three consecutive patients with solid tumors and normal mental status examinations were screened within 48 hr during two study periods. The intensity of patient pain was assessed using a visual analogue scale (VAS) which was given to the patient, his/her primary care nurse, house officer and medical oncology fellow. Sixty-three percent of the patients were taking narcotic analgesics on admission to the hospital. Although there was a correlation between patient and health care provider ratings for the entire group, no statistically significant correlation between the patient's VAS pain score and that of his/her nurse, house officer, or oncology fellow was present in the 44 patients with VAS greater than or equal to 4.0. Agreement between patient and caregiver VAS scores was also examined. When patients rated their pain from 7-10 on the VAS scale, nurses, house officers, and oncology fellows would place their rating of the patient's pain in this range 7%, 20%, and 27% of the time, respectively. Improved correspondence was noted with lower patient VAS scores. This study demonstrates that health care provider impressions of patient pain are often quite different than those of the patient and that these discrepancies are most pronounced in patients with significant pain. The routine use of pain assessment tools, such as the VAS, could enhance patient-caregiver communication and improve care for patients with cancer pain.
癌症疼痛治疗不足已得到广泛认可。本研究旨在确定医疗服务提供者与其患者之间关于疼痛强度的沟通不足是否可能是干扰癌症疼痛控制的一个重要因素。在两个研究期间的48小时内，对103例连续的实体瘤患者且精神状态检查正常的患者进行了筛查。使用视觉模拟量表（VAS）对患者、其初级护理护士、住院医师和肿瘤内科住院医师评估患者的疼痛强度。63%的患者入院时正在服用麻醉性镇痛药。尽管整个组患者与医疗服务提供者的评分之间存在相关性，但在44例VAS大于或等于4.0的患者中，患者的VAS疼痛评分与其护士、住院医师或肿瘤内科住院医师的评分之间不存在统计学上的显著相关性。还检查了患者与护理人员VAS评分之间的一致性。当患者在VAS量表上将其疼痛评为7 - 10时，护士、住院医师和肿瘤内科住院医师分别会在7%、20%和27%的时间内将患者的疼痛评级置于该范围内。患者VAS评分较低时，一致性有所改善。本研究表明，医疗服务提供者对患者疼痛的印象往往与患者的印象有很大不同，而且这些差异在疼痛严重的患者中最为明显。常规使用疼痛评估工具，如VAS，可以加强患者与护理人员之间的沟通，并改善对癌症疼痛患者的护理。
