To Know Another's Pain: A Meta-analysis of Caregivers' and Healthcare Providers' Pain Assessment Accuracy.

Abstract

Acute and chronic pain affects millions of adults yet it is often inadequately assessed and treated. The purpose of the present meta-analysis was to examine the overall level of pain assessment accuracy among caregivers and providers and identify patient, observer, and assessment level factors that moderate pain assessment accuracy. A systematic literature search was conducted in PubMed and PsycINFO to identify studies addressing providers' pain assessment accuracy, or studies that compared patients' self-report of pain with observers' (healthcare providers, caregivers, and strangers) assessment of pain. We present two separate meta-analyses examining the overall effect of under-/overestimation of pain and correlational pain assessment accuracy. Seventy-six articles meeting inclusion criteria yielded 94 independent effect sizes for the correlational accuracy meta-analysis. Ninety articles yielded 103 independent effect sizes for the paired comparison meta-analysis. The correlational pain assessment meta-analysis showed that in general, observers were significantly better than chance when assessing pain; however, the paired comparison meta-analysis showed that observers significantly underestimated patients' pain. Patient's age and gender, pain type, and provider type moderated these effects. Results suggest that certain healthcare providers and caregivers need training to more accurately assess patient pain and that there are particular groups of patients who may be at a greater risk for having their pain inaccurately assessed.