Feasibility and Acceptability of a Patient- and Family-Oriented Approach to Pain Assessment in the Intensive Care...

Family caregivers (i.e., family members, close friends) may be able to help assess pain in intensive care unit (ICU) patients. However, suitable methods for family caregivers to assess pain in the ICU have yet to be identified.

To evaluate the feasibility and acceptability of independently collecting patient and family caregiver assessments of patient pain and to determine agreement between pain scores.

Adult patients who could communicate pain ratings and their family caregivers (creating patient-family caregiver dyads) from a single ICU in Calgary, Alberta, Canada were asked to simultaneously provide independent (unaware of the other's response) assessments of the patient's pain (beginning 4 January 2023) using: (1) a yes/no response on the presence of pain, (2) pain intensity on the Numerical Rating Scale, and (3) open text descriptions of pain. The feasibility of obtaining pain assessments from dyads was determined by the percent of dyads recruited compared to dyads approached. Acceptability was determined by calculating completion rates of dyads in this study. Cohen's kappa (κ) and intraclass correlation coefficients (ICC) [95% confidence intervals] were used to determine inter-dyad agreement.

Of 458 patients admitted to the study ICU during the recruitment period, 45 dyads were approached for participation. Thirty-four dyads (75.6%) consented (feasibility outcome) and completed (100%) the study (acceptability outcome). Agreement was moderate between yes/no pain responses (κ = 0.45 [0.16-0.76]) and good between patient and family caregiver Numerical Pain Scale scores (ICC = 0.75 [0.56-0.87]). Of the 18 dyads who provided open text descriptions of the pain, 13 (72.2%) were similar for patients and family caregivers.

Collecting independent, simultaneous pain assessments from patient-family caregiver dyads in the ICU appears feasible and acceptable, and family caregivers appear to provide good proxy reports of the patient's pain.

Family caregiver involvement in pain assessment in the ICU may have the potential to complement clinical pain assessment in select contexts, particularly for patients who are unable to communicate, although further research is needed.