12 CHAPTER 3 CARE OF DYING PATIENTS AND THEIR FAMILIES

information helps them plan their lives. Patients who are told that their would you rather take it day by day?” If the patient requests the la er, the
disease is generally terminal are more likely to spend a longer period of time physician can follow up by asking if there is someone else with whom he or
in hospice and to avoid aggressive technology at the end of life, without she can talk about the prognosis. Second, before giving prognostic informa-
adverse psychological consequences. Furthermore, their families usually have tion, it is useful to inquire about the patient’s concerns in order to provide
fewer postdeath adverse psychological outcomes. information in the most useful manner. Finally, it is appropriate when dis-
Given that one cannot guess how much information to provide, a physician cussing prognostic information to acknowledge uncertainty: “ e course of
can start these conversations by asking, “Are you the kind of person who this cancer can be quite unpredictable, and physicians don’t have a crystal
wants to hear about what might happen in the future with your illness or ball. I think you should be aware of the possibility that your health may

STUDY ID# HOSPITAL ID#

DO NOT WRITE ABOVE THIS LINE

Brief Pain Inventory (Short Form)

Date: Time:
Name:
Last First Middle Initial

1. Throughout our lives, most of us have had pain from time to time (such as minor headaches, sprains, and toothaches). Have you
had pain other than these everyday kinds of pain today?

1. Yes 2. No

2. On the diagram, shade in the areas where you feel pain. Put an X on the area that hurts the most.

Right Left Left Right

3. Please rate your pain by circling the one number that best describes your pain at its worst in the last 24 hours.

0 1 2 3 4 5 6 7 8 9 10
No Pain as bad as
pain you can imagine

4. Please rate your pain by circling the one number that best describes your pain at its least in the last 24 hours.

0 1 2 3 4 5 6 7 8 9 10
No Pain as bad as
pain you can imagine

5. Please rate your pain by circling the one number that best describes your pain on the average.

0 1 2 3 4 5 6 7 8 9 10
No Pain as bad as
pain you can imagine

6. Please rate your pain by circling the one number that tells how much pain you have right now.

0 1 2 3 4 5 6 7 8 9 10
No Pain as bad as
pain you can imagine
FIGURE 3-1. Brief Pain Inventory (short form). (Copyright 1991. Charles S. Cleeland, PhD, Pain Research Group. All rights reserved.)
 CHAPTER 3 CARE OF DYING PATIENTS AND THEIR FAMILIES 13

7. What treatments or medications are you receiving for your pain?

8. In the last 24 hours, how much relief have pain treatments or medications provided? Please circle the one percentage that most
shows how much relief you have received.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
No Complete
pain relief

9. Circle one number that describes how, during the past 24 hours, pain has interfered with your:

A. General Activity

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

B. Mood

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

C. Walking Ability

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

D. Normal Work (includes both work outside the home and housework)

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

E. Relations with Other People

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

F. Sleep

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes

G. Enjoyment of Life

0 1 2 3 4 5 6 7 8 9 10
Does not Completely
interfere interferes
FIGURE 3-1, cont’d.

deteriorate quickly, and you should plan accordingly. We probably are dealing It is also important for physicians to recognize their own emotional reac-
with weeks to months, although some patients do be er, and some do worse. tions to these conversations. e physician’s emotional reactions color impres-
Over time, the course may become clearer, and if you wish, I may be able to sions of the patient’s prognosis, thereby making it hard to listen to the patient,
be a li le more precise about what we are facing.” and may in uence the physician to hedge bad news. e physician should
e physician must discuss these topics in an empathic way. Palliative care become aware of her or his own emotional reactions to ensure that the con-
conversations are as much about emotions as facts.5 Talking about disease versation focuses on the patient rather than the health care provider’s needs.
progression or death may elicit negative emotions such as anxiety, sadness, or In addition to good communication skills, palliative care requires a basic
frustration. ese emotions decrease a patient’s quality of life and interfere knowledge of medical ethics and the law. For example, patients have the
with the ability to hear factual information. Empathic responses strengthen moral and legal right to refuse any treatment, even if refusal results in their
the patient-physician relationship, increase the patient’s satisfaction, and death. ere is no legal di erence between withholding and withdrawing
make the patient more likely to disclose other concerns. e rst step is rec- life-sustaining treatment. When confronted with areas of ambiguity, the
ognizing when the patient is expressing emotions. Once the physician recog- physician should know how to obtain either a palliative care or ethics
nizes the emotion being expressed, he or she can respond empathically. consultation.
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