Pain barriers: psychometrics of a 13-item questionnaire.

BACKGROUND: Research instruments that effectively measure key pain constructs without needlessly taxing participants are invaluable to investigative processes. OBJECTIVES: The purposes of this series of studies were to eliminate the redundancy of the commonly used 27-item pain tool, the Barriers Questionnaire (BQ-27); retain its theoretical domains; and maintain its psychometric properties in a new shortened version. METHOD: The BQ-27 was reduced to 13 items using data from 259 patients with cancer by selecting the single item from each domain with the highest frequency of endorsement and including all of the items in the side effects subscale. We tested reliability of the BQ-13 using data from additional studies (n = 221 and 166) and used analysis of covariance (n = 221) to determine instrument sensitivity. RESULTS: Confirmatory factor analysis revealed that the BQ-13 contained two constructs: pain management and side effects. The BQ-13 demonstrated internal consistency as a total scale (alpha = .73) and stability via 4-week test-retest reliability. In addition, the BQ-13 was sensitive, F(1,218) = 7.7, p = .006, to effects of a tailored multimedia educational intervention. DISCUSSION: The BQ-13 retained theoretical constructs, eliminated redundant items likely to contribute to floor effects, maintained adequate internal consistency and stability reliability, and had sensitivity to intervention effects.

Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease.

Despite frequent episodes of severe recurrent pain in sickle cell disease (SCD), sensory pain in outpatient adults with SCD lacks sufficient characterization. Furthermore, pivotal barriers may interfere with these patients' adherence to prescribed analgesic therapies but have not been studied systematically. We describe sensory pain characteristics, barriers, and analgesic use reported by adults with SCD during routine clinic visits. Patients (N = 145; 67% female, 94% African American) completed measures on a pen-tablet computer. Patients reported an average of 3.6 +/- 2.3 pain sites; mean current pain intensity (3.3 +/- 3.2), least (3.0 +/- 2.7) and worst (4.9 +/- 3.5) pain intensity in 24 hours on a 0 to 10 scale, multiple neuropathic (4.5 +/- 3.4, 8.3% selected none) and nociceptive (6.8 +/- 4.0) pain descriptors, and continuous pain pattern (59%). Their mean pain barriers score was 2.2 +/- 0.9, and 33% were dissatisfied with their pain levels. Only 14% reported taking at least 1 adjuvant drug, 82% were taking nonopioids, 85% step 2 opioids, and 65% step 3 opioids. Patients reported using, on average, 4.9 +/- 2.7 analgesics. Their pain barriers scores were similar to or greater than people with cancer. Importantly, their pain may be both nociceptive and neuropathic, contrary to common expectations that SCD pain is only nociceptive. Few patients, however, took drugs effective for neuropathic pain.

Correlates of physical activity in young adult survivors of childhood cancers.

PURPOSE/OBJECTIVES: To examine correlates of participation in regular physical activities among young adult survivors of childhood cancers. DESIGN: Descriptive, correlational. SETTING: Web-based survey. SAMPLE: 117 well-educated, predominately Caucasian survivors of various types of childhood cancers (-X age = 24 years). METHODS: Participants completed four rating scales, a stages of change measure, and background questions. Logistic regression and graphical methods were used to examine relationships among physical activity correlates and physical activity. MAIN RESEARCH VARIABLES: Physical activity stages of change, autonomous motivation, physical activity pros and cons, self-efficacy, and self-reported worries. FINDINGS: More than 80% of participants reported that they were physically active. Survivors who were autonomously motivated and who perceived fewer cons to being physically active were more likely to report being active than survivors with lower autonomous motivation scores and higher physical activity cons scores. Worries about the present and future moderated the effect of physical activity cons on physical activity. The estimated probabilities of reporting being active for women and men changed as the collective contribution of autonomous motivation, physical activity cons, and worries varied from low to high values. CONCLUSIONS: Engaging in physical activity willingly and without a sense of pressure (autonomous motivation), perceiving fewer cons to physical activity participation (cognitive appraisal), and worrying about the present and future (affective response) were important correlates of self-reported physical activity beyond the influence of gender. IMPLICATIONS FOR NURSING: Interventions that promote autonomous motivation, decrease physical activity cons, and address present and future worries may increase physical activity in young adult cancer survivors and may have a greater impact on women than men.

Developing a computerized data collection and decision support system for cancer pain management.

Contemporary nursing practice needs reengineering to deliver its service effectively and efficiently. Using computer technology to support clinicians' decision making may be a parsimonious way to provide high-quality, patient-centered, efficient care. The process of developing the PAINReportIt and PAINConsultN system is described, and the results of two pilot studies in which the system was tested are summarized. The feasibility of using the system to assess pain and provide decision support for clinicians is demonstrated. The findings show PAINReportIt to be promising as an effective, efficient way for patients to report their pain. Whether PAINConsultN is an effective answer to cancer pain management barriers warrants further evaluation with larger samples. The advantages of using the system, as compared with use of the traditional pain management process, are discussed.

Usability of a computerized PAINReportIt in the general public with pain and people with cancer pain.

We examined usability (completion time, acceptability, and completeness of information) of a computerized format for pain assessment, PAINReportIt. PAINReportIt is the first interactive software extension of the 1970 McGill Pain Questionnaire. Two hundred thirteen patients experiencing pain were recruited for this descriptive, comparative study. Subjects used a Microsoft Windows 95/98 personal computer with a touch-screen to complete 1) PAINReportIt, 2) demographic, and 3) acceptability questions. Qualitative and quantitative data from the study support PAINReportIt as a feasible method for patients to self-report their pain. Patients completed the tool in less than 18 minutes on average, answered all sections, and scored it high regarding acceptability. Improved directions and practice screens would likely improve patients' independence in completing PAINReportIt, which would free clinicians to focus direct communication on more complex pain issues.