Comparison of patient-reported and clinician-assessed pain in hospitalized palliative ward patients: A retrospective observational study

Background: Pain assessment in palliative care is essential, but differences between patient-reported and clinician-assessed pain can affect care decisions. Identifying factors contributing to these differences can improve pain management. Aim: To investigate the clinical and symptom-related factors associated with variations between patient-reported and clinician-assessed pain among patients admitted to a palliative care ward. Design: A retrospective observational study using palliative care outcomes collaboration instruments was conducted from July 2021 to September 2023. Setting/participants: The study included 755 terminally ill patients admitted to a palliative ward in Taiwan. Pain was assessed daily using the symptom assessment scale for patient-reported pain and the palliative care problem severity score for clinician-assessed pain. Results: Among 755 palliative care patients (median age = 69 years; 59.3% female), 181 were classified into the different group and 574 into the similar group based on initial patient-reported and clinician-assessed pain scores. Patients in the different group were younger, had a higher proportion of cancer diagnoses, and reported significantly higher levels of pain, fatigue, bowel problems, and difficulty sleeping. In multivariate analysis, bowel problems were the only independent factor associated with being in the different group (odds ratio = 1.07; 95% confidence interval = 1.01–1.14; p = 0.025). Conclusions: Patients in the different group exhibited greater symptom burden compared to those in the similar group, particularly in pain, fatigue, and bowel problems. Bowel problems independently predicted differences between patient-reported and clinician-assessed pain scores. These results indicate that differences in pain assessment are linked to the severity and complexity of physical symptoms, reinforcing the need for comprehensive, symptom-based evaluations in palliative care.