General Practitioners knowledge of and attitude to assessment and management of pain in people with dementia.

Conference:

SAPC ASM 2018 - London

Talk Code:

4E.5

Presenter:

Aisling Jennings

Twitter:

@aislingjennings

Co-authors:

Maura Linehan, Tony Foley

Author institutions:

Dept. of General Practice University College Cork

Problem

People with dementia have a significantly increased risk of pain. Despite the existence of several pain assessment tools pain in dementia is often underdiagnosed, underestimated and undertreated. Pain in a person with dementia can present with behavioural symptoms such as agitation. As a result, unrecognised pain can potentially result in the inappropriate prescribing of psychotropic medication. Understanding GPs' knowledge of and attitudes to pain management in dementia is a critical step in improving the detection and management of pain in dementia, however, no previous research has explored this topic. The aim of this study is to explore the knowledge and attitudes of general practitioners to the identification and management of pain in people with dementia.

Approach

An anonymised postal survey was sent to a random selection of 200 gGPs in the Republic of Ireland. The 24-item questionnaire was adapted from a previous questionnaire conducted with nurses and was piloted with 5 GPs. The questionnaire collected demographic information on the GP’s dementia workload and Likert-style statements explored the knowledge and attitudes of the GPs to pain in people with dementia. Statistical analysis using SPSS was performed in order to identify any association between the demographic data collected and GPs’ knowledge of and attitudes towards pain in dementia.

Findings

107 completed questionnaires were received, a response rate of 53.5% (107/200). Overall, GPs were very knowledgeable on most aspects of assessing and managing pain in people with dementia. However, there was some uncertainty regarding the prescribing of opioids in people with dementia and in the use of dementia-specific pain assessment tools. The majority of the respondents (74/107) felt that pain was under-recognised in patients with dementia. The majority of respondents (79/107) believed that a pain assessment tool would be useful to increase recognition of pain in patients with dementia in nursing home settings. Over two-thirds (74/107) of respondents had a nursing home commitment caring for a total of 1,596 patients in nursing homes. Respondents estimated that more than half of these nursing home patients (851/1,596) had dementia. However, only 16% of the GPs with nursing home commitment (12/74) were aware of existing guidelines or policies for the management of pain in dementia in the nursing homes that they attended. Neither the length of time qualified nor the extent of the GP’s nursing commitment influenced the GP’s knowledge of or attitude to pain management in dementia.

Consequences

This study highlights the value of GP educational programmes that focus on pain assessment and management in people with dementia. Current pain assessment tools for people with dementia are not being used by front-line practitioners. This gap between research and clinical settings needs to be addressed if we are to effectively assess and manage pain in this high-risk, vulnerable population.

Submitted by:

Aisling Jennings

Funding acknowledgement:

This work was conducted as part of a larger research project - PREPARED (Primary Care Education, Pathways and Research of Dementia). PREPARED is supported by a three year grant (2015–2018) from Atlantic Philanthropies and the Health Service Executive, Ireland. The lead author, A. Jennings, is in receipt of a PhD stipend from this grant. A. Jennings is also in receipt of a three year career research grant from the Irish College of General Practitioners (2017–2020). The funders played no role in the design, execution, analysis or writing of the study.