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Table 3 Characteristics of triads of patient-physician, by two categories of accurate pain assessment and under-diagnosis of pain by primary physicians

From: Under-diagnosis of pain by primary physicians and late referral to a palliative care team

 

Coexisisting moderate or Severe pain6) (N = 213)

 

Accurate pain assessment (N = 192)

Under-diagnosis of pain by primary physicians (N = 21)

 

Variables

Number

Percentage

Number

Percentage

p-value†

Age

 Median (Range)

68 (22-94)

 

65 (41-82)

 

0.71

Gender

 Male

112

52.6

11

5.2

0.60

 Female

80

37.5

10

4.7

 

KPS

 Median (Range)

40 (10-80)

 

40 (10-80)

 

0.79

Primary cancer site

 Respiratory tract

29

13.5

3

1.4

0.98

 Gastrointestinal tract and liver/galbladder/pancreas

53

24.9

6

2.8

 

 Genitourinary

70

32.9

7

3.3

 

 Others

40

18.8

5

2.4

 

Treatment status at initial PCT consultation

 Chemotherapy/Radiotherapy/Surgery/Diagnosis

95

44.6

8

3.8

0.32

 Only symptom management

97

45.5

13

6.1

 

Purpose of admission

 Chemotherapy/Radiotherapy/Surgery/Diagnosis

77

35.7

10

4.7

0.48

 Only symptom management

115

54.4

11

5.2

 

Coexistence of delirium

 Yes

21

9.9

4

1.9

0.27

 No

171

80.2

17

8.0

 

Current opioid use at initial PCT consultation

 Yes

83

39.0

9

4.2

0.97

 No

109

51.1

12

5.7

 

Duration of hospitalization (Days)

 Median (Range)

34 (2-394)

 

42 (8-293)

 

0.06

Interval between admission and initial PCT consultation (Days)

 Median (Range)

4 (0-148)

 

25 (0-251)

 

< 0.0001**

Clinical department of primary physician

 Internal medicine less-experienced oncology 1),5)

41

19.3

7

3.3

0.33

 Internal medicine more-experienced oncology 2),5)

66

31.0

7

3.3

 

 Surgery3) and Urology/Obstetrics and Gynecology

65

30.5

7

3.3

 

 Others4)

20

9.4

0

0

 

Experience of primary physician

 < 6years

22

10.4

3

1.4

0.17

 6-10years

81

38.0

13

6.2

 

 > 10years

89

41.8

5

2.3

 
  1. * p<0.05.
  2. **p<0.01.
  3. *** p<0.001.
  4. †Compared according to the two categories of pain assessment: accurate pain assessment and under-diagnosis of pain by primary physicians.
  5. †Wilcoxon rank-sum test for age, KPS, duration of hospitalization, and interval between admission and initial consultation to PCT;χ² for gender, primarycancer site, tratment status at initial PCT consultation, purpose of admission, coexistence of delirium, current opioid use at initial PCT consultation, durationof hospitalization, interval between admission and initial PCT consultation, clinical departments of primary physician, and experience of primary physician.
  6. 1) General medicine, Internal medicine specialized Renal and Cardiovascular.
  7. 2) Internal medicine specialized Gastroenterological, Respiratory, Hematology, and Oncology.
  8. 3) Surgery specialized Upper and Lower gastroenterological, Hepato-Biliary-Pancreatic Surgery, Respiratory, Mammary gland, and Thyroid.
  9. 4) Orthopedic surgery, Otorhinolaryngology, Dermatology, and Oral surgery.
  10. 5) Less-experienced and more-experienced oncology was defined by cancer patient data from the hospital register.
  11. 6) We defined coexisting moderate or severe pain as intensity of pain was ≧ 4 on the Numerical Rating Scale (NRS) rated by patients, or ≧8 on the AbbeyPain Scale (APS) documented by palliative care physicians with the form for palliative care physicians at the initial consultation to a PCT.
  12. PCT; Palliative Care Team.
  13. KPS; Karnofsy Performance Stasus.
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BMC Palliative Care

ISSN: 1472-684X

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