Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study.

BACKGROUND: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. OBJECTIVE: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. METHODS: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System-Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. RESULTS: The portal adoption rate was 72% (103/143), and the portal use rate was 76.7% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67% (69/103). The combined completion rate of the ESASr and DT&PL was 78.4% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33% (26/79) initiated messaging, 73% (58/79) received messages, and 85% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age (ß=-.45), ESASr engagement (ß=.5), symptom interference (ß=.4), and received knowledge (ß=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age (ß=-.31), ESASr engagement (ß=.37), symptom interference (ß=.60), self-care self-efficacy (ß=.37), and received knowledge (ß=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P≤.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. CONCLUSIONS: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted.

Sense of security during COVID-19 isolation improved with better health literacy - A cross-sectional study.

OBJECTIVE: To assess sense of security, health literacy, and the association between sense of security and health literacy during COVID-19 self-isolation. METHODS: In this cross-sectional survey all adults who caught COVID-19 from the onset of the pandemic until June 2020 in Iceland and received surveillance from a special COVID-19 outpatient clinic, were eligible. Participants retrospectively answered the Sense of Security in Care - Patients' Evaluation and the European Health Literacy Survey Questionnaire. Data were analysed with parametric and non-parametric tests. RESULTS: Participants' (N = 937, 57% female, median age 49 (IQR=23)) sense of security during isolation was Med 5.5 (IQR=1) and 90% had sufficient health literacy. The proposed regression model (R2 =.132) indicated that those with sufficient health literacy had, on average, higher sense of security than those with inadequate health literacy. CONCLUSION: Sense of security was high among individuals who received surveillance from an outpatient clinic during isolation and was associated with health literacy. The high health literacy rate may be an indication of a high COVID-19 specific health literacy rather than general health literacy. PRACTICE IMPLICATIONS: Healthcare professionals can improve the sense of security of patients through measures to improve their health literacy, including their navigation health literacy, by practising good communication, and providing effective patient education.

Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic.

AIM: To describe nursing surveillance of coronavirus disease 2019 (COVID-19)-infected patients through remote telephone calls and in an on-site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. DESIGN: Qualitative descriptive study. METHODS: Data were collected through seven semi-structured, audio-recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. RESULTS: Nurses relied on intensive listening when assessing and caring for COVID-19-infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, 'Confronting an unfamiliar health condition in unprecedented circumstances' and the categories: 'Digging into the unknown' and 'Ensuring holistic nursing care'. The category 'Contributing to averting catastrophe' reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. CONCLUSION: Novel nursing surveillance through remote telephone calls and in an on-site urgent care clinic delivered to COVID-19 patients self-managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. IMPACT: Findings give a unique insight into nursing surveillance of COVID-19-infected patients provided through telephone calls and in on-site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID-19-infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.

"There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study.

AIM: To provide insight into the contribution of nursing to the establishment and running of a hospital-based outpatient clinic for COVID-19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. DESIGN: Qualitative descriptive study centred on collaboration between nurse managers and researchers. METHODS: Drawing on Donabedian's model of quality health services and the work of Allen on "Nurses' organising work", data were collected using four semi-structured, audio-recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub-categories. RESULTS: "There was no panic - challenged by the unprecedented" was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub-categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub-categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers' decision-making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. CONCLUSION: The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. IMPACT: The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID-19 and of healthcare development more generally.

[Long term effects of burn injury on health-related quality of life of adult burn survivors in Iceland: a descriptive cross-sectional study and validation of the Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B)].

OBJECTIVES: The aim of the study was to assess the long-term effects of burn injury on the health-related quality of life of adult burn survivors in Iceland and to validate the translated Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B). MATERIALS AND METHODS: The participants of this descriptive cross-sectional study were all burn survivors, 18 years or older, admitted to hospital for 24 hours or more because of skin burn during a 15 years period (N=196). They completed questionnaire about their health (BSHS-B), health related quality of life (EQ-5D-5) and additional questions on burn-related symptoms and their burn experience. RESULTS: Response rate was 34% (N=66). Men were 77%, mean age 45.7 years (sf=18.3 and range 18-82 years), mean age when burned was 34.0 (sf=20,1, range 1-75), median time from burn accident was 11.5 years (range 1-44 years) and 32% had been burned when under 18 years of age. Burn-specific health was 4.4-4.0 (median) and health on the EQ5D-5vas scale was 80 (median, range 10-100). Those who lost a body part or had skin transplantation had more negative body image and needed more selfcare than others (p<). A significant proportion of participants reported physical and psychosocial symptoms such as itch (48%), persistent pain (37%), anxiety/depression (29%) and negative self-image (37%). Majority (67%) believed they did not get enough information, follow-up, or support after discharge from hospital. The Icelandic version of the Burn Specific Health Scale-Brief (BSHS-B) was reliable, but more research is needed to establish its validity. CONCLUSION: These findings suggest that most Icelandic burn survivors report acceptable health and health-related quality of life. The study identified a subgroup of survivors that experience persistent physical and psychosocial symptoms. Team approach with holistic support after discharge, for a prolonged period of time aiming at preventing physical and psychiatric morbidity, is recommended.

Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study.

Aims: To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design: Prospective, explorative two-site follow-up study. Methods: Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results: The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

Role of patient education in postoperative pain management.

Postoperative pain continues to be a significant issue in healthcare, with a considerable proportion of patients experiencing severe pain after surgery and finding pain management at home challenging. There are several barriers to effective pain management, involving both patients and healthcare professionals. Patient education may be a useful way to overcome many of these barriers. This article outlines the four stages of the education process, which can be used to provide patient education: assessing the patient's educational needs and potential barriers to learning; setting educational objectives; teaching; and evaluating the patient's learning. This article discusses the issue of postoperative pain and how structured patient education, from admission to discharge, provided by skilled healthcare professionals, may improve postoperative recovery.

The effectiveness of the Pain Resource Nurse Program to improve pain management in the hospital setting: A cluster randomized controlled trial.

BACKGROUND: The Pain Resource Nurse program is a widely disseminated, evidence-based, nursing staff development program, designed to improve pain management in hospitals. The program has shown promising results, but has never been tested with a rigorous research design. OBJECTIVES: Our objective was to test the effectiveness of the Pain Resource Nurse program. Hypothesized outcomes included improvements in nurses' knowledge, attitudes, and assessment practices, and in patients' participation in decision-making, adequacy of pain management, pain severity, time spent in severe pain, pain interference, and satisfaction. DESIGN: Cluster randomized controlled trial. SETTING: A 650-bed university hospital in Iceland Participants: The sample consisted of a) patients ≥18 years of age, native speaking, hospitalized for at least 24h, alert and able to participate; and b) registered nurses who worked on the participating units. METHODS: Twenty three surgical and medical inpatient units were randomly assigned to the Pain Resource Nurse program (n=12) or to wait list control (n=11). The American Pain Society Outcome Questionnaire and the Knowledge and Attitudes Survey were used to collect data from patients and nurses respectively. Baseline data (T1) for patients were collected simultaneously on all units, followed by data collection from nurses. Then randomization took place, and the Pain Resource Nurse program was instituted. Ten months later, follow up (T2) data were collected, after which the nurses on the control group units received the Pain Resource Nurse program. RESULTS: At baseline, data were collected from 305 of the 396 eligible patients and at follow up from 326 of the 392 eligible patients, a 77% and 83% response rate respectively. At baseline, 232 of 479 eligible nurses responded and at follow-up 176 of the eligible 451 nurses responded, a 49% and 39% response rate, respectively. A nested mixed model analysis of covariance revealed that the intervention was successful in changing pain assessment practices, with pain assessment using standardized measures increasing from 13% to 25% in the intervention group while decreasing from 21% to 16% in the control group. None of the other hypothesized improvements were found. CONCLUSIONS: The Pain Resource Nurse program was successful in improving nurses' use of standardized measures for pain assessment. No effects were found on patient outcomes; pain was both prevalent and severe at both time points. Only minimal improvements were noted in response to this evidence-based staff development program. Changes in pain management practices remain a challenge in clinical settings.

Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study.

BACKGROUND: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain. OBJECTIVE: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game. METHODS: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information. RESULTS: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001). CONCLUSIONS: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game's usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

Determinants of Knowledge and Attitudes Regarding Pain among Nurses in a University Hospital: A Cross-sectional Study.

The aim of this cross-sectional study was to evaluate the primary determinants of knowledge and attitudes regarding pain among nurses in a hospital setting. All registered nurses employed at participating units at a university hospital were invited to participate. Information on work experience, education, and hospital unit was evaluated using a questionnaire. The Knowledge and Attitude Survey Regarding Pain instrument was used to assess knowledge on pain management. The difference in knowledge between nurses with different levels of education was assessed with analysis of variance. The discriminatory ability of each question was determined with item response theory, and the association between correct answers to individual items and the total score were calculated using linear regression. Participants were 235 nurses, 51% of the 459 invited. The overall pain knowledge score was 26.1 (standard deviation 5.3, range 8-38) out of a total of 40 possible. Those with an advanced degree in nursing scored on average 2.9 points higher than those who did not have an advance degree (95% confidence interval: 0.9-4.7). Responses to clinical vignette questions showed more difference between nurses with different levels of knowledge of pain management than the other questions. Participants with the correct response to the best discriminatory item had 5.35 (95% confidence interval 4.08-6.61) points higher total score than those with an incorrect answer. Higher education is associated with better knowledge on pain management. To assess pain knowledge, the ability to interpret and solve a clinical vignette leads to better results than answering direct questions.

Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital.

PURPOSE: To examine the attitudes, practices and perceived barriers in relation to a sexual health care educational intervention among oncology health care professionals at the Landspítali-National University Hospital of Iceland. METHODS: The design was quasi experimental, pre - post test time series. A comprehensive educational intervention project, including two workshops, was implemented over a two year time period. A questionnaire was mailed electronically to all nurses and physicians within oncology at baseline (T1, N = 206), after 10 months (T2, N = 216) and 16 months (T3, N = 210). RESULTS: The response rate was 66% at T1, 45% at T2 and 38% at T3. At all time points, the majority of participants (90%) regarded communication about sexuality part of their responsibilities. Mean scores on having enough knowledge and training, and in six of eight practice issues increased significantly over time. Overall, 10-16% reported discussing sexuality-related issues with more than 50% of patients and the frequency was significantly higher among workshop attendants (31%) than non-attendants (11%). Overall, the most common barriers for discussing sexuality were "lack of training" (38%) and "difficult issue to discuss" (27%), but the former barrier decreased significantly by 22% over time. CONCLUSIONS: The intervention was successful in improving perception of having enough knowledge and training in providing sexual health care. Still, the issue remains sensitive and difficult to address for the majority of oncology health care professionals. Specific training in sexual health care, including workshops, should be available to health care professionals within oncology.

Quality Pain Management in Adult Hospitalized Patients: A Concept Evaluation.

AIM: To explore the concept of quality pain management (QPM) in adult hospitalized patients. BACKGROUND: Pain is common in hospitalized patients, and pain management remains suboptimal in some settings. DESIGN: A concept evaluation based on Morse et al.'s method. DATA SOURCE: Of more than 5,000 articles found, data were restricted to 37 selected key articles published in peer-reviewed journals. REVIEW METHODS: Data were extracted from the selected articles and then synthesized according to the following: definition, characteristics, boundaries, preconditions, and outcomes. RESULTS: QPM relates to the Structure: organizationally supported evidence-based policies, competent staff, interprofessional and specialized care, and staff accountability; PROCESS: screening, assessment/reassessment and communication of pain and its treatment, patient/family education, individualized evidence-based treatment, embedded in safe, effective, patient-centered, timely, efficient, and equitable services; and OUTCOMES: reduced pain severity and functional interference, decreased prevalence/severity of adverse consequences from pain or pain treatment, and increase in patient satisfaction. CONCLUSIONS: QPM is a multifaceted concept that remains poorly defined in the literature. Studies should aim to develop valid, reliable, and operational measures of the pillars of QPM and to look at the relationship among these factors. Authors need to state how they define and what aspects of QPM they are measuring.

Quality pain management practices in a university hospital.

Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs.

Quality pain management in the hospital setting from the patient's perspective.

BACKGROUND: Pain management is a crucial issue for patients, and patients' perception of care is an important quality outcome criterion for health care institutions. Pain remains a common problem in hospitals, with subsequent deleterious effects on well-being. OBJECTIVES: To assess the epidemiology of pain (frequency, severity, and interference), patient participation in pain treatment decisions, and patient satisfaction with care in a hospital setting. METHODS: A point-prevalence study was conducted. Data were collected with the American Pain Society Patient Outcome Questionnaire (Icelandic version). Participants (n = 308) were ≥ 18 years old, alert, and hospitalized for ≥ 24 hours. RESULTS: The response rate was 73%. The mean age of participants was 67.5 (SD = 17.4; range 18 to 100) years, and 49% were men. Pain prevalence in the past 24 hours was 83%, mean worst pain severity was 4.6 (SD = 3.1), and 35% experienced severe pain (≥ 7 on 0 to 10 scale). Moderate to severe interference with activities and sleep was experienced by 36% and 29% of patients respectively. Patient participation in decision making was weakly associated with spending less time in severe pain and better pain relief. Patient satisfaction was related to spending less time in severe pain, better pain relief, and lower pain severity (P < 0.05). CONCLUSIONS: Pain was both prevalent and severe in the hospital, but patient participation in decision making was related to better outcomes. Optimal pain management, with emphasis on patient participation in decision making, should be encouraged in an effort to improve the quality of care in hospitals.

Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project.

The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration.

Evaluating the quality of pain management in a hospital setting: testing the psychometric properties of the Icelandic version of the revised American Pain Society patient outcome questionnaire.

Pain management is an important aspect of providing quality health care, and monitoring patient-related outcomes is a recommended quality improvement practice. Valid and reliable tools are needed for this purpose. The American Pain Society Patient Outcome Questionnaire (APS-POQ) is widely used to measure quality of pain management. The APS-POQ was recently revised to reflect advances in pain management. The purpose of this study was to test the psychometric properties of the revised version in Icelandic patients in the hospital setting. The questionnaire was translated according to an adaptation of Brislin's model. Data were collected from 143 patients on 23 wards in a university hospital. Participants were ≥ 18 years old, hospitalized for >24 hours, alert, not too ill to participate, and in pain ≥ 1 on a 0-10 scale in the past 24 hours. Mean (SD) age was 66 (18) years, 51.4% were women, 48.6% men. Principal component analysis with varimax rotation confirmed a five-component structure, but four items lowered reliability and were removed from the scales. The final version consists of four components, with Cronbach α >.70, explaining 64.2% of the variance. Participants had little difficulty in answering the questionnaire, but two additional items about participation in decisions and pain medications were added in response to patients' comments and suggestions. Administering the Icelandic version of the APS-POQ-R was found to be feasible, and the questionnaire has acceptable construct validity and reliability. The results support the use of the APS-POQ-R-I to evaluate the quality of pain management in hospitals in Iceland.