Discrepancies in oral mucositis pain assessment in pediatric oncology: Implications for nursing practice

Oral mucositis (OM) is a frequent and clinically significant complication of chemotherapy in paediatric oncology, often resulting in substantial pain and functional impairment. Despite its prevalence, discrepancies in pain assessment across informants may contribute to suboptimal symptom management. This study examined differences in OM-related pain ratings among children, parents, and nurses, and evaluated agreement between two validated pain assessment instruments.

A cross-sectional design was employed with 45 children receiving chemotherapy in a paediatric hemato-oncology unit, their parents, and six nurses. OM-related pain was assessed using the Visual Analogue Scale (VAS) and the Child Oral Mucositis Evaluation Scale (ChIMES). Inter-rater differences were analysed using comparative statistics, and agreement between raters and instruments was evaluated through correlation analyses.

Nurses reported significantly lower OM-related pain scores compared with both children and parents (p < .001). Strong concordance was observed between parent and child reports, whereas nurse ratings demonstrated only moderate agreement with child self-reports. Notably, fewer than half of children experiencing severe pain received analgesic treatment. No significant differences were identified between VAS and ChIMES scores (p > .05), supporting the consistency of these instruments.

Systematic underestimation of OM-related pain may place children at risk for inadequate symptom control. Incorporating multi-informant assessment strategies and prioritising child self-report, when developmentally appropriate, are critical for improving clinical decision-making and advancing child-centred pain management in paediatric oncology nursing.