• Teofanes Natavio, Elizabeth McQuillen, Mary S Dietrich, Nancy Wells, Bethany A Rhoten, April Hazard Vallerand, and Todd B Monroe.
• College of Nursing, Wayne State University, Detroit, Michigan.
• Pain Manag Nurs. 2020 Dec 1; 21 (6): 502-509.

BackgroundThere is currently no gold standard instrument for assessing pain in severely cognitively impaired adults who are unable to provide self-report.AimsTo determine interrater reliability of the PACSLAC and PAINAD in assessing pain behaviors in patients with the same pain stimulus, determine the consistency of the reliable changes between and within the instruments and assess nurse preference for either instrument.DesignA single-group, within-subjects repeated-measures design was implemented.SettingThe study took place in a small suburban hospital.Participants/SubjectsPain levels were observed at 24, 48, and 72 hours postsurgery using two instruments: Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) and Pain Assessment in Advanced Dementia Scale (PAINAD). These instruments were selected because they are among the most commonly recommended tools for clinical use. Interrater reliability was analyzed along with reliable changes in pain for each period, and the study concluded with the nurse raters completing a preference survey.MethodsA convenience sample of 30 patients was used with a diagnosis of severe dementia rendering the patient unable to reliably express pain, 60+ years of age, recovering from hip fracture surgery.ResultsGreater interrater reliability was found for the PACSLAC, with reliable change potentially affected by the type and level of pain medication. The nurses' preference for the tool was split.ConclusionsThe results of this study indicate that the PACSLAC may be the more reliable tool over the PAINAD; however, rater training and familiarity with the tool is critical.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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