How well do surrogates assess the pain of seriously ill patients?

Objective: To compare pain assessments made by seriously ill hospitalized p atients and their surrogates and to understand factors that might lead to r eporting differences. Design: Cross-sectional study. Setting: Five U.S. teaching hospitals. Patients: Patients were 2,645 of 9,105 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments for whom the re were both patient and surrogate interviews about pain. The majority of p atients had acute respiratory failure, multiple organ system failure with s epsis, exacerbation of chronic obstructive pulmonary disease, and congestiv e heart failure. Interventions: None. Measurements: We queried patients and surrogates by using Likert-type scale questions about the frequency and severity of patients' pain. Main Results: Overall, surrogates correctly estimated presence or absence o f patients' pain 73.5% of the time (kappa = 0.47, 95% confidence interval [ CI], 0.44, 0.50), overestimating 16.8% of the time and underestimating 9.7% of the time. Exact estimation of the presence and level of pain was consid erably poorer, with only 53.0% of surrogates correctly assessing exact leve l of pain (kappa = 0.31; 95% CI, 0.28, 0.33; weighted kappa = 0.43; 95% CI, 0.41, 0.46). Patients' reported level of pain, days in hospital before stu dy admission, time interval between patient and surrogate assessment, and s tudy hospital were associated with inaccuracy in surrogates' estimation of patients' pain. Conclusions: Family members correctly assess the level of pain of hospitali zed patients with moderate success, Further studies are needed to assess th e accuracy of assessment of pain by family members compared with that of he alth professionals, and to determine whether surrogates' accuracy in estima ting patients' pain can be improved.