VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), Menlo Park, California.
RAND Corporation, Santa Monica, California.
Pain Med. 2019 Jan 1;20(1):68-76. doi: 10.1093/pm/pny135.
We aimed to understand providers' experiences and preferences regarding several brief pain screening measures.
We collected two waves of data for this analysis. Wave one: We conducted nine focus groups with multidisciplinary Department of Veterans Affairs (VA) providers. Wave two: To understand an emergent theme in wave one, we conducted 15 telephone interviews with prescribing providers where we used a semistructured guide comparing screening measures currently used in VA practices. Using content analysis of the wave two interviews, we evaluated providers' perceptions of important aspects of brief pain screening measures and reported emergent themes.
Five emergent themes underlie providers' perceptions of the utility of brief pain screening measures: 1) item abstractness: how bounded and concrete a patient's interpretation of an individual item is; 2) item distinctness: belief in the patient's ability to differentiate between the meaning of various items in a pain measure; 3) item anchoring: presence of a description under each response option making the meaning explicit; 4) item look-back period: the period of time over which patients are asked to remember and comment on their pain; 5) parsimony: identifying the shortest and simplest approach possible to acquire desired information.
Overly complex or adaptive screening tools may include information that is ultimately not used by providers. Conversely, overly simplistic pain screening tools may omit information that helps providers understand the impact of pain on patients' lives. As pain is nuanced, complex, and subjective, all screening measures exhibit some limitations. No single pain measure serves all chronic pain patients, and specific contexts or settings may warrant additional specific items.
我们旨在了解提供者对几种简短疼痛筛查措施的经验和偏好。
我们为此分析收集了两波数据。第一波：我们与多学科退伍军人事务部（VA）提供者进行了九次焦点小组讨论。第二波：为了了解第一波中出现的一个主题，我们对 15 名处方提供者进行了电话访谈，在访谈中我们使用了一个半结构化指南，比较了 VA 实践中目前使用的筛查措施。通过对第二波访谈的内容分析，我们评估了提供者对简短疼痛筛查措施的重要方面的看法，并报告了出现的主题。
提供者对简短疼痛筛查措施效用的看法有五个出现的主题：1）项目抽象性：患者对单个项目的解释有多具体；2）项目区分度：相信患者能够区分疼痛测量中各个项目的含义；3）项目锚定：每个反应选项下都有一个描述，使含义明确；4）项目回顾期：患者被要求回忆并评论其疼痛的时间段；5）简约性：尽可能确定最短和最简单的方法来获取所需信息。
过于复杂或适应性强的筛查工具可能包含最终未被提供者使用的信息。相反，过于简单的疼痛筛查工具可能会遗漏有助于提供者了解疼痛对患者生活影响的信息。由于疼痛是复杂、主观的，所有的筛查措施都存在一些局限性。没有一种单一的疼痛测量方法适用于所有慢性疼痛患者，具体的情况或环境可能需要额外的具体项目。
