Healthcare workers’ judgments about pain in older palliative care patients with and without delirium

Delirium can interfere with the assessment and management of pain in older advanced cancer patients. This retrospective cohort study investigated whether healthcare workers’ (HCWs) pain judgments differ between older patients with advanced cancer who have been diagnosed with delirium and those who have not. We reviewed HCWs’ daily chart notations about pain in patients with advanced cancer, ≥ 65 years of age, who were admitted to a palliative care inpatient unit within a one-year period (N = 149). Proportions of days during hospitalization that HCWs judged patients to have pain and good pain control were calculated. Patients with and without a delirium diagnosis and across different delirium subtypes and trajectories were compared on both pain outcomes. The moderating effect of highest analgesic class administered was examined. Although most patients received opioid analgesics, mean proportions of days with judged pain were high (39%–60%), and mean proportions of days with judged good pain control were low (< 25%) across groups. HCWs judged that patients with delirium had significantly fewer days of good pain control than patients without delirium. The group difference in judged pain control was evident in patients who received either opioid or non-opioid medication. Cancer pain management is a mandate of palliative care, and our findings highlight the urgent need for better pain assessment in older patients with advanced cancer who have delirium, including a psychometrically sound protocol to assess pain accurately in this clinical group.