Consistency analysis of perioperative self-reported pain scores and clinical records in patients with lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yaqin ¹ , YU Hongfan ² , DAI Wei ¹ , WEI Xing ¹ , LIAO Jia ¹ , HU Xiaoqun ¹ , GONG Ruoyan ³ ,  SHI Qiuling ^1,2 ,  LIU Xiaoqin ¹

1. Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;
2. State Key Laboratory of Biomedical Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, P. R. China;
3. School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding?author：

SHI Qiuling, Email: qshi@cqmu.edu.cn; LIU Xiaoqin, Email: 594922003@qq.com

Keywords：

Lung cancer; surgery; pain; patient-reported outcomes; clinical records

DOI：

10.7507/1007-4848.202202050

Video：

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Objective To analyse the consistency of perioperative self-reported pain scores of lung cancer patients with clinical records to provide a basis for optimal pain management. Methods The patients with lung cancer who underwent surgical treatment in the Department of Thoracic Surgery, Sichuan Cancer Hospital from November 2017 to January 2020 were selected. They were divided into two groups based on the source of pain data. The self-report group used a questionnaire in which patients self-reported their pain scores, and the pain scores for the clinical record group were extracted from the electronic medical record system. Kappa test was used to compare the concordance of pain scores between the two groups preoperatively, on postoperative 1-6 days and on the day of discharge. McNemar's paired χ² test was used to compare the differences in pain intensity levels between the two groups. Binary logistic multi-factor regression was used to analyse the factors influencing the concordance of severe pain (7-10 points) between the two groups. Results Totally 354 patients were collected, including 191 males and 163 females, with an average age of 55.64±10.34 years. The median postoperative hospital stay was 6 days. The consistency of pain scores between the two groups was poor (Kappa=–0.035 to 0.262, P<0.05), and the distribution of pain levels at each time point was inconsistent and statistically significant (P<0.001). The percentage of inconsistent severe pain assessment ranged from 0.28% to 35.56%, with the highest percentage of inconsistent severe pain assessment on postoperative day 1 (35.56%). Single-port thoracoscopic surgical access was an influencing factor for inconsistent assessment of severe pain on postoperative day 3 (OR=2.571, P=0.005). Conclusion Self-reported perioperative pain scores of lung cancer patients are poorly aligned with clinical records. Clinical measures are needed to improve the accuracy of patient pain data reporting by choosing the correct assessment method, increasing education, and developing effective quality control measures.

Citation： WANG Yaqin, YU Hongfan, DAI Wei, WEI Xing, LIAO Jia, HU Xiaoqun, GONG Ruoyan, SHI Qiuling, LIU Xiaoqin. Consistency analysis of perioperative self-reported pain scores and clinical records in patients with lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1545-1550. doi: 10.7507/1007-4848.202202050 Copy

1.	Gjeilo KH, Oksholm T, Follestad T, et al. Trajectories of pain in patients undergoing lung cancer surgery: A longitudinal prospective study. J Pain Symptom Manage, 2020, 59(4): 818-828.
2.	潘巧, 李漓, 王靈曉. 成人術后急性疼痛管理指南中疼痛評估內容的質量評價與分析. 現代臨床護理, 2020, 19(4): 53-59.
3.	中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
4.	中國抗癌協會腫瘤麻醉與鎮痛專業委員會. 中國腫瘤患者圍術期疼痛管理專家共識(2020版). 中國腫瘤臨床, 2020, 47(14): 703-710.
5.	冷希圣, 韋軍民, 劉連新, 等. 普通外科圍手術期疼痛處理專家共識. 中華普通外科雜志, 2015, 30(2): 166-173.
6.	ACHEON Working Group, Kim YC, Ahn JS, et al. Current practices in cancer pain management in Asia: A survey of patients and physicians across 10 countries. Cancer Med, 2015, 4(8): 1196-1204.
7.	Missair A, Cata JP, Votta-Velis G, et al. Impact of perioperative pain management on cancer recurrence: An ASRA/ESRA special article. Reg Anesth Pain Med, 2019, 44(1): 13-28.
8.	Shangguan XF, Yu ZQ, Ji L, et al. Cognition and sociodemographic determinants for effective pain control in patients with cancer pain: A cross-sectional survey in China. Curr Med Sci, 2020, 40(2): 249-256.
9.	Zhang Q, Yu C, Feng S, et al. Physicians' practice, attitudes toward, and knowledge of cancer pain management in China. Pain Med, 2015, 16(11): 2195-2203.
10.	Darawad M, Alnajar MK, Abdalrahim MS, et al. Cancer pain management at oncology units: Comparing knowledge, attitudes and perceived barriers between physicians and nurses. J Cancer Educ, 2019, 34(2): 366-374.
11.	Brown D. A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people. J Clin Nurs, 2004, 13(6B): 74-90.
12.	王錫唯, 徐軍, 周惟. 開胸術后患者疼痛的自我評估與護士評估間差異的比較研究. 中國實用護理雜志, 2012, 28(11): 71-72.
13.	濮麗萍, 聞彩芬, 秦月香. 病人和護生對疼痛程度的評估差異的調查分析. 護理研究, 2010, 24(36): 3302-3303.
14.	Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain, 2016, 17(2): 131-157.
15.	Dai W, Xie S, Zhang R, et al. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: A multicentre, prospective, observational cohort study protocol. BMJ Open, 2019, 9(10): e030726.
16.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 1987, 40(5): 373-383.
17.	Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: The validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory. Oncologist, 2011, 16(2): 217-227.
18.	張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評. 腫瘤, 2013, 33(5): 434-438.
19.	Shawd M. 28th annual conference of the International Society for Quality of Life Research. Qual Life Res, 2021, 30(S1): 1-177.
20.	Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(8): 977-1007.
21.	郭軼斌, 郭威, 秦宇辰, 等. 基于Kappa系數的一致性檢驗及其軟件實現. 中國衛生統計, 2016, 33(1): 169-170, 174.
22.	Wand BM, Chiffelle LA, O'Connell NE, et al. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain. Eur Spine J, 2010, 19(4): 633-640.
23.	Schofield P. The assessment of pain in older people: UK national guidelines. Age Ageing, 2018, 47(suppl_1): i1-i22.
24.	Im EO, Liu Y, Kim YH, et al. Asian American cancer patients' pain experience. Cancer Nurs, 2008, 31(3): E17-E23.
25.	Xia Z. Cancer pain management in China: Current status and practice implications based on the ACHEON survey. J Pain Res, 2017, 10: 1943-1952.
26.	陳學輝. PDCA循環管理對普外科護理人員疼痛評估正確率的影響. 臨床醫藥文獻電子雜志, 2020, 7(59): 113, 115.
27.	魏建梅, 劉韋辰, 王志劍, 等. 疼痛評估管理指標提高疼痛評估完整率的臨床應用. 中國疼痛醫學雜志, 2021, 27(4): 282-286.
28.	U. S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes, 2006, 4: 79.
29.	中華護理學會. 成人癌性疼痛護理 T/CNAS 01-2019. http://www.zhhlxh.org.cn/cnaWebcn/article/2389-.
30.	Hill BL, Lefkowits C. Strategies for optimizing perioperative pain management for the cancer patient. Surg Oncol Clin N Am, 2021, 30(3): 519-534.
31.	Feng Y, Dai W, Wang Y, et al. Comparison of chief complaints and patient-reported symptoms of treatment-naive lung cancer patients before surgery. Patient Prefer Adherence, 2021, 15: 1101-1106.
32.	Wei X, Yu H, Dai W, et al. Patient-reported outcomes of video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancer: A longitudinal cohort study. Ann Surg Oncol, 2021, 28(13): 8358-8371.
33.	Dai W, Dai Z, Wei X, et al. Early patient-reported outcomes after uniportal vs multiportal thoracoscopic lobectomy. Ann Thorac Surg, 2022, 114(4): 1229-1237.

1. Gjeilo KH, Oksholm T, Follestad T, et al. Trajectories of pain in patients undergoing lung cancer surgery: A longitudinal prospective study. J Pain Symptom Manage, 2020, 59(4): 818-828.
2. 潘巧, 李漓, 王靈曉. 成人術后急性疼痛管理指南中疼痛評估內容的質量評價與分析. 現代臨床護理, 2020, 19(4): 53-59.
3. 中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
4. 中國抗癌協會腫瘤麻醉與鎮痛專業委員會. 中國腫瘤患者圍術期疼痛管理專家共識(2020版). 中國腫瘤臨床, 2020, 47(14): 703-710.
5. 冷希圣, 韋軍民, 劉連新, 等. 普通外科圍手術期疼痛處理專家共識. 中華普通外科雜志, 2015, 30(2): 166-173.
6. ACHEON Working Group, Kim YC, Ahn JS, et al. Current practices in cancer pain management in Asia: A survey of patients and physicians across 10 countries. Cancer Med, 2015, 4(8): 1196-1204.
7. Missair A, Cata JP, Votta-Velis G, et al. Impact of perioperative pain management on cancer recurrence: An ASRA/ESRA special article. Reg Anesth Pain Med, 2019, 44(1): 13-28.
8. Shangguan XF, Yu ZQ, Ji L, et al. Cognition and sociodemographic determinants for effective pain control in patients with cancer pain: A cross-sectional survey in China. Curr Med Sci, 2020, 40(2): 249-256.
9. Zhang Q, Yu C, Feng S, et al. Physicians' practice, attitudes toward, and knowledge of cancer pain management in China. Pain Med, 2015, 16(11): 2195-2203.
10. Darawad M, Alnajar MK, Abdalrahim MS, et al. Cancer pain management at oncology units: Comparing knowledge, attitudes and perceived barriers between physicians and nurses. J Cancer Educ, 2019, 34(2): 366-374.
11. Brown D. A literature review exploring how healthcare professionals contribute to the assessment and control of postoperative pain in older people. J Clin Nurs, 2004, 13(6B): 74-90.
12. 王錫唯, 徐軍, 周惟. 開胸術后患者疼痛的自我評估與護士評估間差異的比較研究. 中國實用護理雜志, 2012, 28(11): 71-72.
13. 濮麗萍, 聞彩芬, 秦月香. 病人和護生對疼痛程度的評估差異的調查分析. 護理研究, 2010, 24(36): 3302-3303.
14. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain, 2016, 17(2): 131-157.
15. Dai W, Xie S, Zhang R, et al. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: A multicentre, prospective, observational cohort study protocol. BMJ Open, 2019, 9(10): e030726.
16. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 1987, 40(5): 373-383.
17. Mendoza TR, Wang XS, Lu C, et al. Measuring the symptom burden of lung cancer: The validity and utility of the lung cancer module of the M. D. Anderson Symptom Inventory. Oncologist, 2011, 16(2): 217-227.
18. 張立力, 臧瑜. MD安德森癥狀評估量表肺癌模塊的修訂和考評. 腫瘤, 2013, 33(5): 434-438.
19. Shawd M. 28th annual conference of the International Society for Quality of Life Research. Qual Life Res, 2021, 30(S1): 1-177.
20. Swarm RA, Paice JA, Anghelescu DL, et al. Adult cancer pain, version 3. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(8): 977-1007.
21. 郭軼斌, 郭威, 秦宇辰, 等. 基于Kappa系數的一致性檢驗及其軟件實現. 中國衛生統計, 2016, 33(1): 169-170, 174.
22. Wand BM, Chiffelle LA, O'Connell NE, et al. Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute low back pain. Eur Spine J, 2010, 19(4): 633-640.
23. Schofield P. The assessment of pain in older people: UK national guidelines. Age Ageing, 2018, 47(suppl_1): i1-i22.
24. Im EO, Liu Y, Kim YH, et al. Asian American cancer patients' pain experience. Cancer Nurs, 2008, 31(3): E17-E23.
25. Xia Z. Cancer pain management in China: Current status and practice implications based on the ACHEON survey. J Pain Res, 2017, 10: 1943-1952.
26. 陳學輝. PDCA循環管理對普外科護理人員疼痛評估正確率的影響. 臨床醫藥文獻電子雜志, 2020, 7(59): 113, 115.
27. 魏建梅, 劉韋辰, 王志劍, 等. 疼痛評估管理指標提高疼痛評估完整率的臨床應用. 中國疼痛醫學雜志, 2021, 27(4): 282-286.
28. U. S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes, 2006, 4: 79.
29. 中華護理學會. 成人癌性疼痛護理 T/CNAS 01-2019. http://www.zhhlxh.org.cn/cnaWebcn/article/2389-.
30. Hill BL, Lefkowits C. Strategies for optimizing perioperative pain management for the cancer patient. Surg Oncol Clin N Am, 2021, 30(3): 519-534.
31. Feng Y, Dai W, Wang Y, et al. Comparison of chief complaints and patient-reported symptoms of treatment-naive lung cancer patients before surgery. Patient Prefer Adherence, 2021, 15: 1101-1106.
32. Wei X, Yu H, Dai W, et al. Patient-reported outcomes of video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancer: A longitudinal cohort study. Ann Surg Oncol, 2021, 28(13): 8358-8371.
33. Dai W, Dai Z, Wei X, et al. Early patient-reported outcomes after uniportal vs multiportal thoracoscopic lobectomy. Ann Thorac Surg, 2022, 114(4): 1229-1237.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Consistency analysis of perioperative self-reported pain scores and clinical records in patients with lung cancer

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