A direct observation of pain scale use in five video-recorded palliative care consultations: Using conversation analysis to show how practitioners support patients to describe pain.
Laura Jenkins, Ruth Parry, Christina Faull
PMID 34736828WHAT IT FOUND
In five palliative care consultations, patients answered pain scales with ranges or extra details, and some misunderstood the numbers.
Doctors let patients expand and handled confusion without blaming them.
Key findings
01In the analysed pain-scale episodes, patients gave ranges or extra descriptors, such as 'three four' or 'moderate at times', conveying variable pain.
02Misunderstandings about numerical scales occurred in two of five pain-scale episodes, and doctors avoided blaming the patient when clarifying.
03When a patient began to answer, the doctor stopped explaining the scale rather than talking over them, giving space for fuller descriptions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 5 consultations included pain scale use, so the findings are patterns in a small, specific set of recordings. The study observed palliative medicine doctors at one UK hospice, not nurses or other clinicians, so it may not apply to all settings or disciplines. It describes talk and assessment process, not whether pain scores were accurate, whether pain control improved, or which communication method is best.
Declared interests
The authors declared no conflicts of interest. The work was funded by the University of Nottingham, The Health Foundation, and the National Institute for Health Research.
The easy way to misread this
Do not conclude that numerical pain scales are unreliable and should be abandoned. The study only observed 5 pain-scale episodes and did not compare pain scales with another assessment method or measure patient outcomes.