Healthcare professionals’ reports of the cues used to identify cancer pain in older people with delirium: a qualitative-quantitative content analysis

Context: Healthcare professionals (HCP) currently judge pain presence and intensity in patients with delirium despite the lack of a valid, standardized assessment protocol. However, little is known about how they make these judgements. This information is essential to develop a valid and reliable assessment tool. Objectives: to identify pain cues that HCP report utilizing to judge pain in patients with delirium and to examine whether the pain cues differ based on patient cognitive status and delirium subtype. Methods: Mixed qualitative-quantitative design. Doctors and nurses were recruited. All participants provided written informed consent and prior to the recorded interview, demographic information was collected. Participants were asked to describe their practices and beliefs regarding pain assessment and management with older patients who are cognitively intact or who have delirium. Interviews were transcribed verbatim by Wordwrap and coded for pain cues. Coded data were imported into SPSS to conduct bivariate analyses. Results: The pain cue self-report and agitation were stated more often by the HCP s for intact and delirium patients, respectively. Considering the subtypes of delirium, the HCP s stated yelling χ2 (2, N = 159) = 11.14, p=0.004, when describing pain in hyperactive than in hypoactive and mixed delirium patients; and significantly more HCP s stated grimace χ2 (2, N = 159) = 6.88, p=0.03, when describing pain in hypoactive than hyperactive and mixed patients. Conclusion: This study outlines how HCP report conducting pain assessment in patients with delirium and, also, specify pain behaviour profiles for the subtypes of delirium.