Methodological challenges in conducting instrumentation research in non-communicative palliative care patients.
Karen Snow Kaiser, Deborah B McGuire, Timothy J Keay and 1 others
PMID 31759841WHAT IT FOUND
Pain assessment in non-communicative palliative patients required careful eligibility screening and coding of absent vocalization, because inability to move or speak can falsely suggest no pain.
Key findings
01Written consent from legally authorized representatives limited enrollment to 16 patients in six months, and enrollment increased after a waiver was approved.
02Eligibility criteria excluded patients with hearing loss, severely impaired visual acuity, or quadriplegia because the pain tool required observation of movement and responses.
03For intubated patients who could not vocalize, the team added a code for inability to vocalize instead of scoring no vocalization as no pain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This paper reports research methods and process outcomes, not whether the pain tool accurately assessed pain or improved patient care. It describes only the tertiary acute care hospital setting; the hospice setting was not included because its challenges were different. The consent waiver that increased enrollment may not be approved by other review boards or in other countries. The initial video-based training was not enough for reliable ratings, and the team said more comprehensive training was needed.
Declared interests
The study was funded by the National Institute of Nursing Research. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not read this as evidence that the MOPAT accurately assesses pain or improves outcomes. It describes methodological challenges in a study, not validation results or patient outcomes.