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Is satisfaction with pain management a valid and reliable quality indicator for use in nursing homes?
David J Casarett1, Karen B Hirschman, Elizabeth R Miller
1Philadelphia VA Medical Center, Pennsylvania, USA. casarett@mail.med.upenn.edu
Objectives:
To determine whether satisfaction with pain management can be measured reliably in nursing homes and to gather preliminary data about the validity of satisfaction assessments in this population.
Design:
Cross-sectional interview study.
Setting:
Two urban nursing homes.
Participants:
Sixty-six nursing home residents with pain.
Measurements:
Overall satisfaction with pain management, satisfaction with pain medication, experiences related to pain management, cognitive function, depressive symptoms, and retest reliability of overall satisfaction rating.
Results:
Most residents (60/66; 91%) could rate their overall satisfaction with pain management. Overall satisfaction was weakly correlated with pain severity at the time of the interview (Spearman correlation coefficient = -0.28; P =.033) and over the past week (-0.27; P =.038). Overall satisfaction was also negatively associated with the Geriatric Depression Scale score (-0.50; P <.001). Satisfaction with pain medication was associated with several ratings of the medication's beneficial effects, including improved activity, sleep, and speed of relief, but not with the frequency with which it caused side effects. Ratings of overall satisfaction showed good reliability overall (kappa = 0.62; P <.001) and for those with Mini-Mental State Examination scores greater than 21 (kappa = 0.70; P <.001) and 21 or less (kappa = 0.54; P =.004).
Conclusion:
These results suggest that satisfaction with pain management can be measured reliably when residents are able to report their pain, but further research is needed before satisfaction with pain management can be incorporated into routine assessments in nursing homes.