P-52 Existing observational pain assessment tools that are potentially transferable to assess pain in end of life care: a systematic review

Background Pain is a common symptom in dying patients. Observational pain assessment tools have been developed in other patient groups, such as those suffering from dementia or Alzheimer’s, or ventilated, comatose patients. This systematic review aims to establish whether existing observational pain assessment tools could be transferrable to pain assessment in dying patients, thus facilitating managing pain in end of life care. Methods The systematic review was undertaken using databases CINAHL and EMBASE. Publications were identified that had assessed the clinical usage of observational pain assessments in patient groups unable to self-report their pain. Key words included in the search were Dementia, Alzheimer’s, cognitively impaired, ventilated, comatose, observational pain assessment. Papers were selected from the last 10 years, available in English and used with adults. Results The database search found 212 publications. Nine were found to assess the clinical usage of observational pain assessment tools and had not adapted the tool (Dementia/Alzheimer’s n=5, ventilated/comatose n=4). Pain assessment tools included were PACSLAC, PAINAD, APS, MOBID, BPS and CPOT. Observational pain assessments are advantageous when the patient is unable to express verbally. Facial expressions, vocalisations and body movements can be used to interpret pain behaviours, and associated pain assessments are quick and simple to use. In addition to better pain management, this can lead to less stress for the carer, the patient and their families. Conclusion There are observational pain assessment tools trialled in specific patient groups, but limited recognised evidence-based pain assessment tools for dying patients that cannot self-report. Although there are some disadvantages to observational pain assessments, there is potential to increase evidence-based practice and improve patient outcomes, by implementing an observational pain assessment tool for dying patients.