Pain and anxiety during bone marrow aspiration/biopsy: Comparison of ratings among patients versus health-care professionals

Abstract

Purpose: To assess pain and anxiety during bone marrow aspiration/biopsy (BMA) among patients versus health-care professionals (HCPs).

Method: 235 adult hematologic patients undergoing BMA were included. BMA was performed by 16 physicians aided by nine registered nurses (RNs). Questionnaires were used to obtain patients and HCPs ratings of patients' pain and anxiety during BMA. Patterns of ratings for pain and anxiety among patients HCPs were estimated with proportions of agreement P(A), Cohen's kappa coefficient (κ), and single-measure intra-class correlation (ICC). We also explored if associations of ratings were influenced by age, sex, type and duration of BMA.

Results: The P(A) for occurrence of rated pain during BMA was 73% between patients and RNs, and 70% between patients and physicians, the corresponding κ was graded as fair (0.37 and 0.33). Agreement between patients and HCPs regarding intensity of pain was moderate (ICC=0.44 and 0.42). Severe pain (VAS>54) was identified by RNs and physicians in 34% and 35% of cases, respectively. Anxiety about BMA outcome and needle insertion was underestimated by HCPs. P(A) between patients and RNs and patients and physicians regarding anxiety ranged from 53% to 59%. The corresponding κ was slight to fair (0.10-0.21). ICC showed poor agreement between patients and HCPs regarding intensity of anxiety (0.13-0.36).

Conclusions: We found a better congruence between patients and HCPs in pain ratings than in anxiety ratings, where the agreement was low. RNs and physicians underestimated severe pain as well as anxiety about BMA outcome and needle insertion.

Fig. 1.

Intensity of pain during BMA. Data of 185 patients/185 RNs ratings who both reported that patient experienced pain during BMA. Intra-Class Correlation (ICC) 0.44 and 95% confidence interval (CI) 0.27–0.58.

Fig. 2.

Intensity of pain during BMA. Data of 156 patients/156 physicians’ ratings who both reported that patient experienced pain during BMA. Intra-Class Correlation (ICC) 0.42 and 95% confidence interval (CI) 0.23–0.56.