Analysis of Commonly Used Pain Assessment and Management Tools in Palliative Care: A Cross-Sectional Study in Embu and Machakos County Referral Hospitals - Kenya

Abstract

 Pain is the main concern in palliative care. Palliative care involves assessment and management of physical, emotional and spiritual pain including other distressing symptoms in a life of patients facing serious life - limiting illnesses with their families. To measure the impact of palliative care interventions, you require reliable, valid assessment tools for different conditions in evaluation. Pain can be malignant or benign and may accompany a disease process such as cancer, arthritis, HIV and others. Unfortunately most pain management tools were ineffective for assessing pain in special populations.

Objective: While pain assessment was a prerequisite for appropriate management of acute and chronic pain, there were some concerns about the use of pain intensity scoring systems. To analyze the commonly used pain assessment and management tools in palliative care, a cross-section study was conducted in Embu and Machakosi County Referral Hospitals in Kenya,

Methodology: From April to July 2019, a two- phase cross sectional study conducted among 258 healthcare workers aged above 20 years was used to establish and analyze the commonly used pain assessment and management tools in those referral hospitals and hospices. In phase one, a pretested questionnaire modified from the Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP) tool was administered to 238 nurses. Systematic random sampling was performed using Slovin’s formula to get the 238 participants from 600 nurses working in the clinical areas based on convenience, availability and Kenyan citizenship.

In phase two, 20 key informant interviewees were recruited from the Ministry of Health headquarters, County health offices, Teaching institutions, Hospices and Kenya Hospice and Palliative care Association (KEHPCA). Purposive sampling was done based on qualifications, position (nurse managers, oncologist & experts working in KEHPCA) and their availability. A key informant's interview guide was used to collect information regarding policies, gaps etc. To test the validity of the data collection tools, pretesting was conducted at Thika Level Five Hospital. Data entry was done in epidata 3.1. Quantitative data was analyzed in Stata Version 14 and in Excel while Qualitative data was analyzed using Thematic analysis.

Results: Commonly utilized pain assessment tools were; the numerical rating scales, history taking and physical examination, Faces and PQRST methods. Gaps identified in the tools included inability to assess pain in special populations, monitor or manage treatment outcomes, use of pain intensity scoring systems could be classified as single-dimensional or multidimensional.

Conclusion: Successful Pain assessment and management interventions depend on the choice of method used. Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individuals with their families. To increase the number of Professionals in pain management, policy makers need to change legislation to allow nurses trained in Palliative Care to prescribe opioid analgesics to their patients (P17). Nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia.

Recommendations:  The WHO ladder for pain management should be adhered to without forgetting utilization of other assessment tools like FLACC for pediatric patients, PAINAD scale for those with dementia and BPS for those with impaired consciousness by Nurses. It is time for clear guidelines and empowerment of the palliative care givers. Embrace Home Based Care to improve Patient monitoring. Review new approaches such as neuromodulation, nerve blocks, intrathecal drug administration, and non-pharmaceutical protocols.