Examining the pain care quality (PainCQ-33) survey as a measure of pain management care perception among older nursing home residents with chronic pain
O'Connor, Timothy Dennis
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Problem under Investigation: Current pain assessment instruments do not adequately address how older adults in nursing homes perceive interdisciplinary pain management care (IPMC), therefore, evaluation of a new instrument that measures IPMC perception is warranted. Objective: To examine the Pain Care Quality (PainCQ-33) as a measure of IPMC perception. Purpose: To determine the usefulness of the PainCQ-33 as a measure of sustained perception in IPMC among older nursing home residents with chronic pain. Aims: (1) to determine the face validity of the PainCQ-33 survey; (2) to identify the PainCQ-33 survey as a measure of sustained perception in IPMC; and (3) to determine if scores from the PainCQ-33 survey correlate with a resident's length of stay (LOS) while controlling covariates pain intensity, depression, scheduled pain medication, age, and gender. Previous Findings: Resident barriers to effective pain management exist including knowledge deficits, attitudes and beliefs, mood and behaviors, and expectations for pain management. Research Design: This study used a test-retest for sustained repeatability with a convenience sample of n = 56-residents from four nursing homes in Western New York. A resident's sustained perception of IPMC, the dependent variable, was compared to their LOS in the nursing home, the independent variable, which was predicted to illustrate how residents become complacent with nursing home care, including IPMC, over time. Residents completed the PainCQ-33 survey at baseline (Time One), and again 14-days later (Time Two). Additional instruments measured covariates including: (1) the Faces Pain Scale - Revised for pain intensity ratings, (2) the five-item Geriatric Depression Scale for depression, and (3) the Clinical Data Form (CDF) for scheduled pain medication, age, and gender. In addition, field notes were taken of the comments made by residents about the PainCQ-33 including clarity of the survey items. Field notes included comprehension and difficulty residents had in responding to the survey items. Data Analysis: Face validity of the PainCQ-33 was examined using descriptive content analysis to code field notes depicting the comments residents made when completing the PainCQ-33 survey. A paired sample correlation was used on the scores from the PainCQ-33. In addition, PainCQ-33 scores were compared to LOS while controlling covariates using ANCOVA. Results: Face validity for the PainCQ-33 was supported by most of the residents who felt the survey was meaningful including those who understood and found relevance in the survey items. In addition, responses to the PainCQ-33 survey at baseline and 14-days later were significantly correlated. Finally, ANCOVA was significant for the residents' length of stay (LOS) in the nursing home and for depression. Potential Significance: With modifications in order to adapt the survey to a nursing home setting, the PainCQ-33 instrument has the potential for being a useful quality improvement tool for identifying how residents perceive the quality of their pain management care.