Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study

The effectiveness of educational interventions in enhancing health professionals' and students' pain assessment for people living with dementia: A systematic review

OBJECTIVES

To evaluate the effectiveness of educational interventions in improving the knowledge, attitudes, beliefs, self-efficacy, and confidence of health professionals' and students' pain assessment in dementia.

DESIGN

A systematic review was conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Eight English databases were searched: Medline, Psychological Information Database, Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature, ProQuest, Scopus, and Web of Science.

REVIEW METHODS

Databases were searched without any time limit using synonyms for "health personnel", "health students", "pain assessment", "dementia", "educational intervention", "knowledge", "attitude", "beliefs", "self-efficacy", and "confidence". The review included studies published up to 26 March 2024. Reference lists and review papers were screened to identify additional papers. Data was synthesised according to the intervention designs and outcome measures and presented narratively.

RESULTS

The seven studies retained involved 517 registered nurses, 17 physical therapists, eight occupational therapists, 17 physicians, 99 nursing students, and 161 medical students. All seven studies evaluated the effectiveness of educational interventions on knowledge, three on attitudes, two on confidence, one on self-efficacy, and none on beliefs of pain assessment in dementia. Health professionals' and students' knowledge scores improved irrespective of the training delivery mode and duration. Their confidence scores improved irrespective of training duration. Health professionals' self-efficacy scores improved upon completion of online training. Overall attitude scores for most health professionals and students did not increase upon educational intervention completion, irrespective of the training delivery mode and duration. Educational interventions mainly focused on methods that assess pain in both communicative and non-communicative people with dementia.

CONCLUSIONS

Educational interventions enhance health professionals' and students' knowledge, self-efficacy, and confidence in pain assessment in dementia. Studies showed mixed findings related to attitudes, and there is a limited understanding of interventions' effectiveness in correcting erroneous beliefs.

Protocol for a usability and pilot implementation study of a digital medical device to assess pain in non-verbal people with dementia in Portuguese residential care facilities

Objective

People living with moderate to severe dementia (PLWD) are often unable to self-report pain. This matter is of particular concern given that up to 80% experience chronic pain. Mistreated or untreated pain in PLWD is associated with symptoms such as agitation and aggression, and unnecessary use of antipsychotic agents. Further, it can also engender mental burden in formal caregivers. The PainChek® App, a regulatory cleared class I medical device, enables the assessment and monitoring of pain in people who cannot verbalise it, such as those with moderate to severe dementia. To date there are no data on the real-world use of the PainChek® App in Portugal. To address this gap, we report the protocol of a pilot study, which combines usability evaluation and implementation research.

Methods

Usability evaluation of the PainChek® (Portuguese) App will be guided by the ISO framework, focused on effectiveness, efficiency and user satisfaction. Implementation research will combine qualitative interviews to inform the implementation process, a longitudinal study of formal caregivers' psychological variables, implementation outcomes, plus qualitative interviews to explore the 'hows' and 'whys' of implementation. The NASSS framework will be used as an implementation framework, together with the COM-B model and the Theoretical Domains Framework.

Results

The usability and implementation studies have received ethics approval from the Egas Moniz Ethics Committee, under numbers 1367 and 64/24, respectively.

Conclusion

This study is expected to inform the scale-up of the PainChek® (Portuguese) App in real-world settings and establish a foundation for a larger effectiveness and implementation study.

Incorporation of "Artificial Intelligence" for Objective Pain Assessment: A Comprehensive Review

Pain is a significant health issue, and pain assessment is essential for proper diagnosis, follow-up, and effective management of pain. The conventional methods of pain assessment often suffer from subjectivity and variability. The main issue is to understand better how people experience pain. In recent years, artificial intelligence (AI) has been playing a growing role in improving clinical diagnosis and decision-making. The application of AI offers promising opportunities to improve the accuracy and efficiency of pain assessment. This review article provides an overview of the current state of AI in pain assessment and explores its potential for improving accuracy, efficiency, and personalized care. By examining the existing literature, research gaps, and future directions, this article aims to guide further advancements in the field of pain management. An online database search was conducted via multiple websites to identify the relevant articles. The inclusion criteria were English articles published between January 2014 and January 2024). Articles that were available as full text clinical trials, observational studies, review articles, systemic reviews, and meta-analyses were included in this review. The exclusion criteria were articles that were not in the English language, not available as free full text, those involving pediatric patients, case reports, and editorials. A total of (47) articles were included in this review. In conclusion, the application of AI in pain management could present promising solutions for pain assessment. AI can potentially increase the accuracy, precision, and efficiency of objective pain assessment.