Patient reluctance to discuss pain: Understanding stoicism, stigma, and other contributing factors
JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE | Online – 15 February 2017 –Some patients are hesitant to disclose when they are experiencing pain. However, the reasons for this, such as stoicism and concern about being a bother to others, are poorly understood. If patient pain goes unrecognized during clinical encounters, patients may also be at greater risk for pain-related crises, use of hospice/palliative care on-call services, and in-patient transfers. The authors used a review of the available evidence to better understand the various factors that contribute to an unwillingness to disclose one’s pain, create a conceptual model, and identify relevant assessment measures that may be useful to practitioners. Their review identified six primary attitudes and beliefs that contribute to patient reluctance to openly admit pain: 1) Stigma; 2) Stoicism; 3) Cautiousness; 4) Fatalism; 5) Bother; and, 6) Denial. Four assessment measures that address elements of barriers to pain-related communication and four measures of non-verbal signs of pain were also identified and reviewed. Based on the model, social workers and other palliative care providers should consistently and vigilantly inquire about how comfortable patients are about discussing their own pain.
PATIENT EDUCATION & COUNSELING | Online – 16 February 2017 – ‘Promoting patient participation in healthcare interactions through communication skills training: A systematic review.’ Most [studies reviewed] targeted primary care or cancer patients and used a randomized controlled study design. Interventions used a variety of training formats and modes of delivering educational material. Reported findings suggest that communication training is an effective approach to increase patients’ total level of active participation in healthcare interactions and that some communication behaviors may be more amenable to training (e.g., expressing concerns).