Communicating comfort: How do cancer outpatients and health care providers talk about pain?

Abstract

229 Background: Pain remains a significant problem for many cancer patients. Poor communication between healthcare providers and patients can contribute to this problem. This secondary analysis explored patient-provider discussions of current pain in the ambulatory oncology setting. Methods: Audio recordings from 66 adult oncology clinic visits in Boston and Seattle were selected from a pre-existing data set of a larger trial. To ensure a diverse sample, all minority recordings (n=33) were selected with a random sample of non-minority recordings (n = 33) matched on patient characteristics. Recordings were reviewed by two independent investigators and each pain discussion was quantitatively coded using 12 variables based on a review of the literature. A pain discussion was defined as any reference to pain or discomfort initiated by either patient or provider. Results: Preliminary analysis of 33 cases revealed 57 separate discussions of pain (6 involved patients denying any pain). Patients and providers were equally likely to initiate discussions about pain (patient initiated total: 27/57; 47%; provider initiated total: 30/57, 53%). Pain discussions overlapped with general symptom assessment, and pain was commonly attributed to effects of oncologic therapy and discussed as stiffness, soreness, or aching, not necessarily as ‘pain.’ Discussions of pain were typically brief and providers asked more close-ended and leading questions (n= 87) versus open-ended questions (n=18) when assessing pain. Providers rarely (n=3) used a validated pain intensity scale (e.g., 0-10) and explored reports of pain slightly more often than acknowledging only (n=27/51; 53%; n=24/51; 47%, respectively). Conclusions: Discussions of cancer related pain in the ambulatory setting are complex, often with multiple reports of pain of varying etiologies discussed throughout the clinic visit. Providers may limit communication by asking mainly close-ended questions and only exploring patient's pain reports about half the time. This analysis offers insights into areas for improvement in communication patterns related to cancer pain.