Stockholm Östergötland Västerbotten Sörmland Gävleborg Jämtland Halland SWEDEN Norrbotten Västernorrland Kalmar Dalarna Örebro Skåne Kronoberg Uppsala Jönköping Blekinge Värmland Västra Götaland Gotland Västmanland
Coverage of Palliative Care Register, % 41 69 63 65 78 76 49 59 59 71 72 74 67 43 72 59 73 75 76 55 67 69
35.0 32.1 28.7 26.2 24.2 22.7 20.5 19.6 19.5 18.1 17.7 17.7 17.6 16.9 15.5 15.4 15.3 15.2 10.3 9.8 8.8 8.6 20
0
40
60
2011
Figure 164
80
100 Percent
Percentage of patients at the end of life who assessed pain intensity on the VAS/NRS scale, January-June 2012. Source: Swedish National Registry of Palliative Care
The indicator in Figure 164 measures process, i.e., the percentage of patients who assessed pain intensity on the VAS/NRS scale or another validated instrument at least once during their final week of life. Pain is a quintessentially personal experience. The preliminary guidelines for palliative care issued by the Swedish Board of Health and Welfare in summer 2012 accorded top priority to pain analysis and assessment. Caregivers have a tendency to underestimate, and family members to overestimate, a patient’s experience of pain. Routine, systematic pain assessment efforts are required to capture and minimise the experience of pain before it is too late. The effort to draw up national guidelines for cancer care concluded that the VAS/NRS scale was the most reliable instrument for patients whose ability to communicate is intact. The Abbey Pain Scale works best for patients with dementia who can no longer describe their pain verbally. The Swedish National Registry of Palliative Care targets the use of pain assessment instruments for 100 per cent of all dying patients. The most important purpose of the indicator is to promote systematic pain assessment that is documented, properly applied and monitored until death. Most people are fearful about the prospect of pain at the end of life.
QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012
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