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Objectives: This study aimed to describe palliative medicine physicians' experiences performing pain assessment using the Numeric Rating Scale (NRS) - one of the most widely used pain assessment tools - for patients with cancer receiving specialised palliative care.

Study design: This qualitative study used reflexive thematic analysis.

Setting: The study was conducted in specialised palliative care settings.

Participants: Semi-structured interviews were conducted with 14 palliative medicine physicians in specialised palliative care.

Analysis: The interviews were transcribed and analysed using reflexive thematic analysis.

Results: Four themes were identified: 'Striving to create a shared understanding',  'Meeting individual needs', 'Interpreting and managing ratings' and 'Importance of organizational structures'. This can be seen as a process that moves from creating a shared foundation through individual patient meetings and handling NRS ratings to organisational-level challenges.

Conclusions: The study shows the complexity needed within palliative cancer care when using the most common pain assessment tool in Sweden, the NRS. The tool may seem simplistic, but, as shown in this study, the physicians found interpreting the assessments challenging for the whole team. This complexity should be incorporated into future healthcare education and training within the palliative care area, where patients often have chronic pain conditions in combination with cognitive impairment. Future research needs to focus on developing reliable pain assessment methods for patients who are cognitively impaired because of the cancer.