The Patients Pain Experience at

UCH and Psychometric

Validation of the Revised
American Pain Society Patient
Outcome Questionnaire
Regina Fink, RN, PhD, AOCN, FAAN
Barbara Krumbach, RN, MSN, CPAN, CCRN
Background
Pain is Critical Success Factor for UCH for 2012-
2013
Information obtained from surveys will be used to
understand the pain experience of patients, pain influence
on functionality, pharmacologic and nonpharmacologic
pain management strategies used, patient involvement in
decision-making about pain

De-identified data will used and combined with data
from other hospital sites to conduct psychometric
testing of the revised instrument, APS-POQ-R
Background
Recognition of inadequacy of pain management has prompted Joint
Commission to publish standards for pain assessment and management in
hospital settings
calls attention to the need for Quality Improvement activities designed to
monitor patient outcomes
Unrelieved pain produces short- and long-term physiological and
psychological adverse consequences.
It degrades patient/family quality of life, increases health care utilization,
drives up health care costs, and prevents early discharge.
In 2010 a task-force of the American Pain Society (APS) developed and
examined psychometric properties of the APSs original Patient Outcome
Questionnaire.
Instrument was revised (APS-POQ-R) and retested in adult hospitalized
medical-surgical patients (n = 299) providing support for the instruments
validity and reliability.
Purpose
To understand the pain
experience of UCH
patients, pain influence
on functionality, pain
management
pharmacologic and
nonpharmacologic
strategies used, and
patient involvement in
decision-making about
pain plan of care.
Methods
COMIRB Approval not deemed human
subjects research
Survey
Adult inpatients (18-89 years) at UCH
All inpatient units and the holding area of
Emergency Department will be sites for
patient sampling
Units not included: Women and Infants and
NICU. Prisoners will not be eligible for
participation in this project


Instrument
American Pain Society (APS) Quality of Care Task Force
Revised Patient Outcome Questionnaire (APS-POQ-R)
The APS Task Force recommended further work be done to
validate findings and explore instrument reliability.
Survey (13-items)
pain severity and relief
impact of pain on activity, sleep, and negative emotions
side effects of treatment
helpfulness of information about pain treatment
ability to participate in pain treatment decisions
use of nonpharmacological strategies



Analysis
Data were entered into
SPSS (Statistical Package
of the Social Sciences)

Data were analyzed
using descriptive
statistics, tests of
difference and
association

Findings: Demographics (N=106)
Average respondent
53 years; Female (55%); Caucasian (80%)
Interviewed 41 hours from admission (range 17-82 hours)
34% had a chronic pain history
23% had a neuropathic pain component
Primary diagnosis
36% medical cancer
13% surgical cancer
26% medical noncancer
25% surgical noncancer
84% were housed on an medical/surgical unit; 6% ICU
Primary pain type
23% chronic persistent cancer-related pain
31% acute other pain
42% acute postoperative pain
2% acute trauma
2% chronic noncancer related pain
15% received an acute pain service consultation




Nursing Unit
Frequency Percent
6W 4 3.8
6E 4 3.8
7W 4 3.8
7E 4 3.8
8W 10 9.4
9W 2 1.9
9E 6 5.7
10W 3 2.8
10E 1 .9
11W 56 52.8
11E 5 4.7
12W 1 .9
MICU 1 .9
SICU 5 4.7
Total 106 100.0

Pain Therapy
0
10
20
30
40
50
60
70
80
%
Pain Intensity: on 0-10 NRS indicate the ___ pain
you had in the first 24 hours
0
1
2
3
4
5
6
7
8
9
10
Least Worst Average
How often were you in severe pain in the
first 24 hours?
Patients said they experienced severe pain 32%
(Mean score) of the time (Range 0-100%)
Pain Interference with Function
Mark the number that describes how much pain interfered or prevented you from.
0
1
2
3
4
5
6
7
8
9
10
Turn, sit, reposition Walk, chair, stand Fall asleep Stay asleep
0=does not interfere; 10=completely interferes
Pain Can Affect Mood and Emotions
Circle the number that best shows how much pain caused you to feel
0
1
2
3
4
5
6
7
8
9
10
Anxious Depressed Frightened Helpless
0=does not interfere; 10=completely interferes
Side Effect Experience
0
1
2
3
4
5
6
7
8
9
10
Nausea Drowsiness Itching Dizziness
0=none; 10=severe
Other Questions
How much pain relief have you received?
Mean = 69.2% (Range = 0-100)
Were you allowed to participate in decisions about your pain
treatment as much as you wanted to?
Mean = 7.7 (Range = 0-10; 0 = not at all; 10 = very much so)
How satisfied are you with the results of your pain treatment
while in the hospital?
Mean = 8.44 (Range = 0-10)
Did you receive any information about your pain treatment
options? 57% yes; 43% DID NOT receive any information
How helpful was this information?
Mean = 8.23 (Range = 0-10)

Non-pharmacologic Interventions Used
66% of patients stated they used a non-pharmacologic intervention
0
5
10
15
20
25
%
Other: positioning, yoga, rubbing, stretching
How often did a nurse or doctor encourage you
to use non-medicine methods for pain relief?
0
10
20
30
40
50
60
70
Never Sometimes Often
%
Goals
Help reduce pain
Introduce non-pharmacologic interventions to reduce pain
Help improve patient and family satisfaction
Help decrease anxiety, depression, feeling of helplessness,
frightened
Help increase amount of sleep

Acknowledgements
A very special thanks for assistance with data collection
Colleen Dingmann
Ali Farmor
Rodney Gill
Barb Krumbach
Lauren Luebbe
Rob Montgomery
Max Swedhin

MS Nursing Students:
John Cockerell, Lori Mulcare, Jamie Rushford