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Open Access Underestimation of Pain by Health-Care Providers: Towards a Model of the Process of Inferring Pain in Others La sous-estimation de la douleur par les prestateurs de soins : vers la conception d'un modèle d'inférence pour évaluer la douleur chez autrui

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Health professionals are routinely exposed to evidence of pain in others. It is important that the processes by which they evaluate pain be understood. The purposes of this article are to review and synthesize recent research on how health professionals judge the pain of others and to present a conceptual model of this process. Methodological and conceptual issues in the conduct of pain judgement studies are addressed. Research in this field over the last 40 years has indicated that, when compared with the pain judgements of patients themselves, health professionals tend to underestimate pain. The authors review the relation of this underestimation bias to such variables as the nature of the patient's pain and the clinical experience of the judge. They also review experiential and cognitive-perceptual variables found to influence the degree of underestimation bias, such as the amount of exposure to evidence of pain and suspicion about the motivations of the patient. A model of the pain decoding process is presented. The issue of whether underestimation has implications for treatment outcome is addressed and priorities for future research are identified.

French
Les professionnels de la santé sont régulièrement exposés aux manifestations de la douleur chez autrui. Il est donc important de comprendre les processus par lesquels ils évaluent celle-ci. Les auteurs présentent une synthèse des travaux de recherche récents sur les moyens d'évaluer la douleur et proposent un modèle conceptuel de ce processus. Ils analysent les questions méthodologiques et conceptuelles découlant de la conduite des recherches sur l'évaluation de la douleur. Les travaux menés dans ce domaine depuis 40 ans révèlent chez les soignants une tendance à sous-estimer l'intensité de la douleur, si on compare leurs évaluations à celles des patients eux-mêmes. Les auteurs analysent le rapport entre cette tendance et des variables comme la nature de la douleur ressentie par le patient et l'expérience clinique du sujet qui pose le jugement. Ils examinent également les variables expérientielles et cognitivo-perceptives censées influer sur le degré de sous-estimation, tels que la fréquence d'exposition aux manifestations de la douleur et les doutes à l'égard des motifs du patient. Enfin, ils présentent un modèle décrivant le processus de décodage de la douleur. Ils réfléchissent aux conséquences de la sous-estimation sur les résultats thérapeutiques et cernent des priorités pour les recherches futures.

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Keywords: ASSESSMENT; BIAS; EXPRESSION; JUDGEMENT STUDIES; PAIN

Document Type: Research Article

Publication date: 2007-06-01

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