Pain is a common symptom in the palliative phase. The quality of both pharmacological and non-pharmacological interventions influences the severity of pain. Pain is measured with a numerical rating scale (NRS) ranging from zero to 10 and moderate to severe pain is classified as the number of patients with a pain score of 4 or above (average over three days). The question is: Which score from zero to 10 would you give for pain? The patient must decide on the score independently. If the patient's health status permits, the patient should preferably also hold the pen.

The number of patients with a pain score of 4 or above on the numerical rating scale (average over three days)

The total number of patients for whom this indicator is measured

Comatose and deeply sedated patients

None

By cognitive impairment status

This indicator must be measured on three consecutive days (1 a day) on a numerical rating scale (NRS). As far as possible, the measurements should take place at the same time each day (e.g., before the daily care rounds). Numerical rating scales are implemented by clinical staff. The question is: Which score from zero to 10 would you give for pain? The patient must decide on the score independently. If the patient's health status permits, the patient should preferably also hold the pen. Pain can be measured in patients with moderate to (very) severe cognitive impairments but not with a numerical rating scale (NRS). Pain in these patients can be measured with a pain observation instrument that was specifically developed for the measurement of patients with cognitive impairments: the Rotterdam Elderly Pain Observation Scale. Measurements with this instrument should also take place on three consecutive days (1 a day) as far as possible at the same time each day (e.g., before the daily care rounds).

Multiple sources: Virdun C, Luckett T, Lorenz KA, Phillips J. National quality indicators and policies from 15 countries leading in adult end-of-life care: a systematic environmental scan. BMJ Support Palliat Care. 2018 Jun;8(2):145-154. doi: 10.1136/bmjspcare-2017-001432; De Roo ML, Leemans K, Claessen SJ, Cohen J, Pasman HR, Deliens L, Francke AL; EURO IMPACT. Quality indicators for palliative care: update of a systematic review. J Pain Symptom Manage. 2013 Oct;46(4):556-72. doi: 10.1016/j.jpainsymman.2012.09.013; Claessen, S et al. (2011). A New Set of Quality Indicators for Palliative Care: Process and Results of the Development Trajectory. Journal of Pain and Symptom Management 42(2), 169–82.

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