Pain Identification and Communication Toolkit (PICT)

PICT was developed in collaboration with CITRA’s affiliate, the Translational Research Institute for Pain in Later Life (TRIPLL), and the College of Nursing at the University of Iowa. PICT is an evidence-based program that can be used to improve the identification and communication of pain in individuals with dementia. Over the course of few training sessions, caregivers learn to recognize and communicate about their care recipient’s pain. PICT can be administered by senior service organizations and health organizations familiar with dementia care and chronic pain management.

Goals and Objective of the Program

Dementia affects more than 5 million older adults in the U.S.; up to 60% of affected individuals suffer from pain. Pain is associated with poor quality of life, emotional disturbance, social withdrawal, sleep impairments, and increased health service use. It also exacts a toll on family relationships and on caregiving relatives’ physical and emotional well-being. Despite its prevalence and impact, the pain remains severely under-detected and undermanaged in this population. The goal of PICT is to train caregivers in observational pain assessment and subsequent communication of the assessment results to a health care provider in order to help improve pain management among persons with dementia.

Structure of the Program

The toolkit consists of a PICT Workbook with six modules and a PICT Appendix that complements each module. These six modules provide an overview of pain experienced in family members with dementia and information on how to recognize pain and communicate effectively with health care providers. The modules offer various pain identification tools such as the Pain Behavior Tool and the Pain Assessment in Advanced Dementia (PAINAD) Tool. Caregivers should be instructed on the use of PICT by a trained interventionist over the course of four weekly training sessions using the PICT Instructor Manual.

Benefits of the Program

PICT is an intervention that provides caregivers (family and friends) of persons with dementia training on how to recognize and communicate about their care recipient’s pain. By receiving training on the use of PICT, caregivers may show improvements in their ability and comfort in recognizing pain symptoms and communicating this information effectively with their health care providers.

Planning and Implementation of the Program

It is recommended that caregivers be trained to use the PICT Workbook and PICT Appendix by a health care professional (e.g., nurse, social worker, physical therapist) who has experience working with older adults and familiarity with dementia care. The PICT Instructor Manual was developed to help health care professionals train caregivers to use PICT. The manual provides an overview of the goals and activities of the PICT Workbook and describes all the sessions and modules in detail.

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