%0 Journal Article
%T Under-diagnosis of pain by primary physicians and late referral to a palliative care team
%A Masako Akashi
%A Eiji Yano
%A Etsuko Aruga
%J BMC Palliative Care
%D 2012
%I BioMed Central
%R 10.1186/1472-684x-11-7
%X This retrospective study was performed in the Teikyo University teaching-hospital for a period of 20£¿months. We investigated triads composed of 213 adult cancer inpatients who had coexisting moderate or severe pain at the initial PCT consultation, 77 primary physicians, and 4 palliative care physicians. The outcome of the present study was the under-diagnosis of pain by primary physicians with routinely self-completed standard format checklists. The checklists included coexisting pain documented independently by primary and palliative care physicians at the time of the initial PCT consultation. Under-diagnosis of pain was defined as existing pain diagnosed by the palliative care physicians only. Late referral to PCTs after admission was defined as a referral to the PCT at ¡Ý20£¿days after admission. Because the two groups displayed significantly different regarding the distributions of the duration from admission to referral to PCTs, we used 20£¿days as the cut-off point for ¡°late referral.¡±Accurate pain assessment was observed in 192 triads, whereas 21 triads displayed under-diagnosis of pain by primary physicians. Under-diagnosis of pain by primary physicians was associated with a longer duration between admission and initial PCT consultation, compared with accurate pain assessment (25£¿days versus 4£¿days, p£¿<£¿0.0001). After adjusting for potential confounding factors, under-diagnosis of pain by the primary physicians was significantly associated with late (20 or more days) referral to a PCT (adjusted odds ratio, 2.91; 95% confidence interval, 1.27£¿£¿£¿6.71). Other factors significantly associated with under-diagnosis of pain were coexisting delirium and case management by physicians with£¿<£¿6£¿years of clinical experience.Under-diagnosis of pain by primary physicians was associated with late referral to PCTs. Shortening the duration from admission to referral to PCTs, and increasing physicians¡¯ awareness of palliative care may improve pain management for cancer patients.
%K Palliative care team
%K Pain
%K Primary physician
%K Cancer
%K Referral
%K Concordance
%U http://www.biomedcentral.com/1472-684X/11/7