Undertreatment of pain in hospitalized patients has been associated with increased length of stay and adverse clinical outcomes such as higher complication rates, slowed would healing, and reduced quality of life. Minority populations have been shown to experience a higher likelihood of poor pain management (Cleeland, Gonin et al., 1994; Bates, Edwards, & Anderson, 1993).
Specific aims are to: 1) describe the perceptions and experiences of Hispanics regarding experience of acute pain and pain management, 2) adapt and translate into Spanish the American Pain Society's Patient Outcome Questionnaire (APS-POQ) to measure outcomes of acute pain management in Hispanics, 3) evaluate the psychometric performance of the modified Spanish language APS-POQ in Hispanics, 4) analyze the factors influencing relationships among demographic variables, selected characteristics of pain, and satisfaction with pain management in an Hispanic sample, and 5) describe outcomes of acute pain management in Hispanics. The project will be conducted in two one-year phases. The purpose of Phase 1 is to understand the experience of acute pain and its management in adult Hispanics. Focus groups will be used to elicit information from Hispanics regarding acute pain experiences, beliefs, expectations related to pain experience and pain relief, and approaches used to manage pain. Data will be gathered on perceptions of satisfaction with pain management and health care providers. Qualitative techniques will be used to analyze the data for themes, in order to develop items for the Beliefs, Interference and Satisfaction subscales of the APS tool. The modified tool will be evaluated for content and cultural validity. The tool will be translated, back-translated and pilot-tested for equivalence of Spanish and English versions. Correlational analysis will be used to test for equivalence; test-retest procedures will examine stability. Phase 2 purposes are to: 1) test the modified APS-POQ for reliability and validity; 2) determine Hispanic satisfaction with overall pain management and with the responses of health care providers; and 3) gather descriptive data regarding the reported effectiveness of pain management strategies, including non-pharmacologic or alternative strategies, in Hispanics. In Phase 2, a cross-sectional study design will test the modified Spanish APS-POQ for internal consistency reliability, construct and convergent validity. In addition to the modified tool, the Brief Pain Inventory will be administered to assess convergent validity, and the Pain Management Index will be computed from analgesic regimen information in the medical record; these scores will be correlated with APS-POQ subscale scores and demographic data. Data from the modified APS tool will be analyzed using factor analysis procedures to establish construct validity. The study will produce a culturally sensitive, reliable and valid tool for determining outcomes of pain management in Hispanics.
