Health Care Worker Beliefs about Pain in Older People with Cancer and Delirium

Objectives: Health care workers (HCWs) may rely on their beliefs about pain to inform treatment decisions. The objectives were to explore HCWs beliefs about pain in older patients with cancer, and compare beliefs among nurses and physicians. Methods: Each physician was matched to one nurse on years of clinical experience (+/- 1 year). Thematic analysis of 16 individual interviews was employed using cognitive mapping to identify themes and patterns. Results: Nurses and physicians beliefs about opioid use were inconsistent, but believed opioids play an important role in the relationship of pain and delirium. HCWs provided inconsistent beliefs about the priority of pain management during delirium. HCWs believed difficulty with self-reporting pain was greater in older than younger patients, and doubted the reliability of older patients reports. HCWs described pain assessment as challenging due to difficulties in distinguishing symptoms of pain and delirium. Conclusions: Knowledge gaps about pain in older people with cancer and delirium are common among HCWs. These findings may inform the development of education interventions.