Virginia T LeBaron1, Traci M Blonquist2, Fangxin Hong2, Barbara Halpenny2, Donna L Berry2. 1. University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA vlebaron@virginia.edu. 2. University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA.
Abstract
PURPOSE: The purpose of this study was to explore concordance between patient self-reports of pain on validated questionnaires and discussions of pain in the ambulatory oncology setting. METHODS: Adult, ambulatory patients (N = 452) with all stages of cancer were included. Three pain measures were evaluated: two items from the Symptom Distress Scale (frequency [SDSF] and intensity [SDSI]) and the Pain Intensity Numeric Scale (PINS). Relevant pain was defined as: (1) scores 3 of 5 on SDSF or SDSI or 5 of 10 on the (PINS); or (2) discussion of existing pain in an audio-recorded clinic visit. For each scale, McNemar's test assessed concordance of patient self-reports of relevant pain with discussions of relevant pain in the audio-recorded clinic visit. Sensitivity, specificity, and accuracy were calculated and a receiver operating characteristic analysis evaluated thresholds on self-report pain questionnaires to best identify relevant pain discussed in clinic. RESULTS: Identification of relevant pain by self-report was discordant (P < .001) with discussed pain coded in audio-recorded visits for all three measures. Specificity was higher for intensity (SDSI, 0.94; PINS, 0.97) than frequency (SDSF, 0.87); sensitivity was higher for frequency (SDSF, 0.35) than intensity (SDSI, 0.24; PINS, 0.12). Accuracy was higher for the SDS pain items (SDSF, 0.57; SDSI, 0.54) than for PINS (0.48). Receiver operating characteristic analysis curves suggest that lower threshold scores may improve the identification of relevant pain. CONCLUSION: Self-report pain screening measures favored specificity over sensitivity. Asking about pain frequency (in addition to intensity) and reconsidering threshold scores on pain intensity scales may be practical strategies to more accurately identify patients with cancer who have relevant pain.
PURPOSE: The purpose of this study was to explore concordance between patient self-reports of pain on validated questionnaires and discussions of pain in the ambulatory oncology setting. METHODS: Adult, ambulatory patients (N = 452) with all stages of cancer were included. Three pain measures were evaluated: two items from the Symptom Distress Scale (frequency [SDSF] and intensity [SDSI]) and the Pain Intensity Numeric Scale (PINS). Relevant pain was defined as: (1) scores 3 of 5 on SDSF or SDSI or 5 of 10 on the (PINS); or (2) discussion of existing pain in an audio-recorded clinic visit. For each scale, McNemar's test assessed concordance of patient self-reports of relevant pain with discussions of relevant pain in the audio-recorded clinic visit. Sensitivity, specificity, and accuracy were calculated and a receiver operating characteristic analysis evaluated thresholds on self-report pain questionnaires to best identify relevant pain discussed in clinic. RESULTS: Identification of relevant pain by self-report was discordant (P < .001) with discussed pain coded in audio-recorded visits for all three measures. Specificity was higher for intensity (SDSI, 0.94; PINS, 0.97) than frequency (SDSF, 0.87); sensitivity was higher for frequency (SDSF, 0.35) than intensity (SDSI, 0.24; PINS, 0.12). Accuracy was higher for the SDS pain items (SDSF, 0.57; SDSI, 0.54) than for PINS (0.48). Receiver operating characteristic analysis curves suggest that lower threshold scores may improve the identification of relevant pain. CONCLUSION: Self-report pain screening measures favored specificity over sensitivity. Asking about pain frequency (in addition to intensity) and reconsidering threshold scores on pain intensity scales may be practical strategies to more accurately identify patients with cancer who have relevant pain.
Authors: Wendy H Oldenmenger; Pleun J de Raaf; Cora de Klerk; Carin C D van der Rijt Journal: J Pain Symptom Manage Date: 2012-09-25 Impact factor: 3.612
Authors: Junya Zhu; Roger B Davis; Sherri O Stuver; Donna L Berry; Susan Block; Jane C Weeks; Saul N Weingart Journal: Cancer Date: 2012-06-06 Impact factor: 6.860
Authors: Donna L Berry; Fangxin Hong; Barbara Halpenny; Ann H Partridge; Jesse R Fann; Seth Wolpin; William B Lober; Nigel E Bush; Upendra Parvathaneni; Anthony L Back; Dagmar Amtmann; Rosemary Ford Journal: J Clin Oncol Date: 2013-12-16 Impact factor: 44.544
Authors: Sherri O Stuver; Thomas Isaac; Jane C Weeks; Susan Block; Donna L Berry; Roger B Davis; Saul N Weingart Journal: J Oncol Pract Date: 2012-03-06 Impact factor: 3.840