How do healthcare workers judge pain in older palliative care patients with delirium near the end of life?

Context: Pain and delirium are commonly reported in older people with advanced cancer. However, assessing pain in this population is challenging and there is currently no validated assessment tool for this task. Objectives: This retrospective cohort study was conducted to understand how healthcare workers (HCWs; nurses and physicians) determine that older cancer patients with delirium are in pain. Methods: We reviewed the medical records of consecutive palliative care inpatients, 65 years of age and above (n = 113), in order to identify patient-based cues used by HCWs to make pain judgments and to examine how the cues differ by delirium subtype and outcome. Results: We found that HCWs routinely make judgments about pain in older patients with delirium using a repertoire of strategies that includes patient self-report and observations of spontaneous and evoked behaviour. Using these strategies, HCWs judged pain to be highly prevalent in this inpatient palliative care setting. Conclusion: These novel findings will inform the development of valid and reliable tools to assess pain in older cancer patients with delirium.