Beyond the Pain Scale

Provider Communication and Staffing Predictive of Patients' Satisfaction With Pain Control

Judith Shindul-Rothschild, PhD, MSN, RN; Jane Flanagan, PhD, RN, ANP-BC; Kelly D. Stamp, PhD, ANP-C, RN, FAHA; Catherine Y. Read, PhD, RN


Pain Manag Nurs. 2017;18(6):401-409. 

In This Article

Patient Satisfaction with Pain Control in Hcahps

The Centers for Medicare and Medicaid Services (CMS) acknowledge that there are no studies suggesting that the pain management domain measured by patients' self-reports in the Hospital Consumer Assessment of Health Care Providers Survey (HCAHPS) has encouraged the overuse of opioid analgesics by health care providers (CMS, 2016). In fact, one study of surgical patients at a tertiary academic medical center found that patient satisfaction with pain management and overall hospital satisfaction was not associated with intra-operative and postanesthesia care unit anesthetics or analgesic interventions (Maher et al., 2015). Nonetheless, CMS is proposing a rule change that would remove the pain management domain from the Hospital Value-Based Purchasing program in 2017 until more appropriate dimensions of pain management related to provider communications and pain can be developed (CMS, 2016).

Nationally the percentage of patients reporting in HCAHPS that their pain is poorly controlled is 7% and is lowest in west North Central region (5%) followed by the New England region (6%), with the Mid-Atlantic and Pacific regions having the greatest percentage of patients reporting their pain was poorly controlled (8%) (HCAHPS, 2013a). Regional variation in patient reports of pain control in HCAHPS may reflect geographically varying hospital practices or socioeconomic or cultural factors (Tighe, Fillingim, & Hurley, 2014). Nonblack minorities, Asians, and patients in poor health have been found to be the least satisfied with their pain control as measured in HCAHPS (Iannuzzi et al., 2015, Li et al., 2016). A study of county-level predictors of pain management in HCAHPS found that 12% of the variability could be predicted by race, gender, ethnicity, and population density (McFarland, Shen, & Holcombe, 2016).

Significant differences have also been reported among government, nonprofit, and for-profit hospitals, with poorer pain control reported in for-profit hospitals and the best pain control reported in government-controlled hospitals (p < .05) (Gupta, Daigle, Mojica, & Hurley, 2009). A follow-up study 5 years later, in 2012, found that patients' perception of pain control improved in for-profit hospitals, but significant differences among the 3 sectors of hospitals persisted (p < .01) (Gupta, Lee, Mojica, Nairizi, & George, 2014).

The quality of the therapeutic relationship between patients and members of the health care team is consistently reported as the strongest predictor of overall patient satisfaction in HCAHPS. Overall satisfaction with hospital care has been found to be associated with nurses and physicians listening, explaining things, treating patients with respect, and controlling pain (p < .001) (Kahn, Iannuzzi, Stassen, Bankey, & Gestring, 2015). These findings are consistent with a national analysis of HCAHPS from 2011 to 2012 that found the strongest correlation with overall hospital satisfaction to be communication with nurses, followed by pain management and responsiveness of hospital staff (p < .001) (HCAHPS, 2013b). Each 1-point increase in patients' satisfaction with nursing care measured in a hospital satisfaction questionnaire by Press Ganey increased the odds of achieving a top overall satisfaction score in HCAHPS by 4.9%—the highest of all 10 hospital care domains (Wolosin, Ayala, & Fulton, 2012).

Nursing care as measured by HCAHPS has been reported to be strongly associated with both high level of patient satisfaction and high levels of patients reporting their pain was well controlled (Craig, Otani, & Herrmann, 2015). Other recent work exploring best practices of nurses suggests nurses have an important role in improving the patient experience of pain. Daniels (2016) found that nurse daily rounding improved communication, patient safety, staff responsiveness, and pain control. Others indicate that a multidisciplinary best practice approach, which was led by nursing and included assessment, education, and patient involvement in pain control, improved HCAHPS scores from the 1st percentile to the 90th in just 5 months (Martin, Kelly, & Roosa, 2012).

Previous studies have examined hospital and patient characteristics associated with patients' perception of pain control measured in HCAHPS. However, prior studies have not examined how specific levels of registered nurse, total nursing staff, hospitalist, physician, and resident/intern staffing affect patient satisfaction with pain management. The aim of this study was to determine which hospital, nursing care, and hospital staffing factors are most predictive of the quality of pain management as measured in HCAHPS.