Pain Management in Older Adults: An Interprofessional Training Approach Assessed by Script Concordance Tests

Optimal perioperative pain management in older adults challenges anesthesiologists due to increased drug sensitivity, altered pharmacokinetics, and limitations of pain assessment tools in cognitively impaired patients. This study evaluated whether a single 60-min structured collaborative training session between a geriatrician and a clinical pharmacist is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by increased concordance with expert opinion on a script concordance test (SCT).

SCT assessed 20 clinical vignettes covering pain assessment, analgesic selection, and adverse effect management domains. These were submitted to anesthesiologists before and after training. A panel of 13 geriatricians established scoring criteria. Internal consistency was measured using Cronbach's alpha. Paired t-tests and Wilcoxon signed-rank tests compared pre- and post-training scores, with the 95% confidence interval (CI) for the overall change estimated by bootstrap resampling.

Seventeen anesthesiologists completed both assessments. Mean SCT scores increased from 45.8 ± 7.4 to 59.5 ± 8.5 post-training (p < 0.001), showing a 29.7% improvement (95% CI, 18.7%-41.7%). Analysis revealed improvements in analgesic prescription (+47.9%; 95% CI, 10.0-28.1 points) and adverse effect management (+26.8%; 95% CI, 9.1-19.0 points), while the change in pain assessment was not statistically significant (-11.6%; 95% CI, -16.6-9.4 points). Internal consistency improved from 0.542 to 0.704. Most participants (89.5%) lacked prior training in prescribing analgesics to older adults, and 73.7% were unfamiliar with clinical guidelines.

This study suggests that collaborative geriatrician-pharmacist training is associated with improved anesthesiologists' clinical reasoning regarding perioperative analgesic management in older adults, as measured by greater concordance with expert opinion on a script concordance test. The varying effects across domains suggest that distinct competencies may require distinct educational approaches. These findings support further investigation of interprofessional education into anesthesiology training to enhance clinical reasoning in the care of older surgical patients.