Not all suffering is pain: sources of patients' suffering in the emergency department call for improvements in communication from practitioners

Richard Body, Ergul Kaide, Sarah Kendal, Bernard Foex

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Provision of prompt, effective analgesia is rightly considered as a standard of care in the emergency department (ED). However, much suffering is not 'painful' and may be under-recognised. We sought to describe the burden of suffering in the ED and explore how this may be best addressed from a patient centred perspective. Methods In a prospective cohort study, we included undifferentiated patients presenting to the ED. We undertook two face to face questionnaires with the first immediately following triage. We asked patients: (a) if they were 'suffering'; (b) how they were suffering; and (c) what they hoped would be done to ease this. Prior to leaving the ED, we asked patients what had been done to ease their suffering. Data were analysed thematically. Results Of 125 patients included, 77 (61.6%) reported suffering on direct questioning and 92 (73.6%) listed at least one way in which they were suffering. 90 (72.0%) patients had a pain score >0/10 but only 37 (29.6%) reported that pain was causing suffering. Patients reported suffering from both physical symptoms (especially pain, nausea, vomiting and dizziness) and emotional distress (notably anxiety). Treatment (to ease physical and emotional symptoms), information ( particularly diagnosis, reassurance and explanation), care (notably friendly staff ) and closure (being seen, resolving the problem and going home) were the key themes identified as important for relief of suffering. Conclusions In seeking to ease suffering in the ED, clinicians must focus not only on providing analgesia but on treating Emotional distress, Physical symptoms, providing Information, Care and Closure (EPICC).

Original languageEnglish
Pages (from-to)15-20
Number of pages6
JournalEmergency Medicine Journal
Volume32
Issue number1
Early online date15 Dec 2014
DOIs
Publication statusPublished - 1 Jan 2015
Externally publishedYes

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