105 CAN OBSERVERS RELIABLY ASSESS ACUTE PAIN AND ANXIETY IN ADOLESCENTS?

Abstract

Because recent studies of discomfort (dis) and anxiety (anx) reduction in children are based on observer and self-reports, the reliability of these reports and the components of suffering need examination. In our study of 10-18 yr. old patients (pts) with cancer, 210 pt and observer (obs) ratings of dis and anx during bone marrow aspirations and lumbar punctures were compared to determine: (1) if the obs could approximate the pt ratings, (2) if the obs became desensitized to the pt's behavior with repeated observations, (3) if the pt's behaviors varied with age, thus influencing the obs reports, and (4) if self-reports of anx, dis, pain, and pressure (pres) relate to each other in determining the amount of suffering during procedures. The inter-rater reliability (IRR) (Pearson's r) for initial procedures was .68 for anx and .53 for dis, both p<.001. In subsequent procedures the IRR was unchanged for anx (r=.71) and dis (r=.60), both p<.0001. For 13-18 yr. olds the IRR for anx was .50 and dis was .44; for 10-12 yr. olds IRR for anx was .71 and dis was .58 (all p<.0001). The IRR for younger pts was significantly higher than in older pts on anx (Z=2.26, p<.03) but not dis. Self-reports of anx, dis, pain, and pres were correlated with each other, all p<.001. The data indicate that an obs can reliably rate the pt's dis and anx in the first contact and the obs does not become desensitized with repeated contacts. Ratings of anx may be more reliable for younger pts. Pt reports of anx, dis, pain, and pres all relate to each other as measures of suffering.

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