Umeå University's logo

umu.sePublications
1213141516171815 of 18
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Pain or no pain? That is the question: an evaluation of the observational pain assessment instrument Abbey Pain Scale in patients with cancer
Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.ORCID iD: 0000-0002-0125-629X
2024 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Smärta eller inte smärta? Det är frågan : en utvärdering av observationssmärtskattningsskalan Abbey Pain Scale vid användning hos patienter med cancer (Swedish)
Abstract [en]

Background: The Abbey Pain Scale (APS) is an observational pain assessment instrument that was created for use among patients with dementia. It is sometimes used in Sweden to assess pain in patients with advanced cancer who are unable to vocalize their pain, but it has never been evaluated in this population.

Aim: To evaluate observational pain assessment for people with advanced cancer in a palliative care setting, focusing on the APS.

Methods: The APS was translated and adapted into a Swedish dementia context through interviews with health care professionals (n=11). The resulting APS-SE was then used in a qualitative content analysis exploring health care professionals’ experience of using the instrument in patients with advanced cancer (n=12). The psychometrics of the APS-SE when used in patients with advanced cancer (n=72) were determined through test-retest and inter-rater reliability, internal consistency reliability, and responsiveness to opioids. Criterion validity was determined against the patients’ self-reported pain (n=45).

Results: The APS-SE was comprehensible by users within dementia care, regardless of their educational and linguistic background. The qualitative analysis revealed that when used in patients with advanced cancer, the APS-SE fulfilled the need for an observational pain assessment instrument, but was not always on target and did not fully suit the clinical situation. The psychometric analysis showed slight criterion validity (κ=0.08) and unacceptable internal consistency reliability (Cronbach’s α=0.01). The test-retest reliability was good (ICC=0.82) and the inter-rater reliability moderate (ICC=0.64), but the latter had a confidence interval ranging from poor to good. Responsiveness to opioids was demonstrated (p=0.01).

Conclusions: This thesis underscores the need for a specialized observational pain assessment instrument explicitly tailored for patients with advanced cancer. The current lack of a recognized alternative emphasizes the importance of developing such an instrument to address the critical gap in observational pain assessment in the palliative oncology setting.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. , p. 95
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2296
Keywords [en]
Abbey Pain Scale, APS-SE, cancer pain, observational pain assessment, advanced cancer, end-of-life care, palliative oncology
National Category
Cancer and Oncology Nursing
Research subject
Oncology
Identifiers
URN: urn:nbn:se:umu:diva-223902ISBN: 9789180703482 (print)ISBN: 9789180703499 (electronic)OAI: oai:DiVA.org:umu-223902DiVA, id: diva2:1855450
Public defence
2024-06-05, Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-05-13 Created: 2024-04-30 Last updated: 2024-05-06Bibliographically approved
List of papers
1. Translation, cultural adaptation and recommendations for clinical implementation of the Abbey Pain Scale to a Swedish dementia care context
Open this publication in new window or tab >>Translation, cultural adaptation and recommendations for clinical implementation of the Abbey Pain Scale to a Swedish dementia care context
2023 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 3, p. 1367-1374Article in journal (Refereed) Published
Abstract [en]

Aim: To translate and culturally adapt the APS for people with end-stage dementia in various care settings in Sweden and to investigate factors important for clinical implementation.

Design: Qualitative study design with interviews with care staff.

Methods: After an initial discussion of concepts, the Abbey Pain Scale was translated into Swedish and back into English to check for accuracy. The resulting Swedish version was then revised and culturally adapted through a series of interviews with nursing assistants, nurses and physicians (n = 11) to develop the final Swedish version.

Results: A Swedish version of the Abbey Pain Scale was developed. The instrument was considered straightforward and easy to use, but needed adjustments to make it more comprehensible to staff with less education in health care or with other first languages than Swedish. It was found important to carefully introduce new staff members to the instrument, to ensure they understand all the words and items.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Abbey Pain Scale, cognitive dysfunction, cross-culture comparison, dementia, development, implementation, pain, pain measurement
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-200371 (URN)10.1002/nop2.1386 (DOI)000865616700001 ()36217250 (PubMedID)2-s2.0-85139418220 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland, AMP 18-922Västerbotten County Council, 7003533
Available from: 2022-11-15 Created: 2022-11-15 Last updated: 2024-04-30Bibliographically approved
2. Physicians’ and nurses’ experience of using the Abbey Pain Scale (APS) in people with advanced cancer: a qualitative content analysis
Open this publication in new window or tab >>Physicians’ and nurses’ experience of using the Abbey Pain Scale (APS) in people with advanced cancer: a qualitative content analysis
2023 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 22, no 1, article id 95Article in journal (Refereed) Published
Abstract [en]

Background: The Abbey Pain Scale (APS), an observational scale used to assess pain in people with end-stage dementia, is also widely used in Sweden to assess pain in patients with advanced cancer. It is unclear whether the APS is appropriate in this context. This study aims to explore physicians’ and nurses’ experiences of using a Swedish translation of the APS (the APS-SE) in people with advanced cancer.

Methods: Conventional qualitative content analysis was used to analyse interviews with physicians (n = 6) and nurses (n = 6) working in oncology and specialised palliative care about their experiences of using the APS-SE.

Results: Three categories were created: fills a need, not always on target, and does not fully suit the clinical situation. Participants reported that although the APS-SE provides support in a challenging situation, it sometimes misses the mark: it does not distinguish well between pain and other types of suffering and its pain score tends not to reflect professionals’ intuitive perceptions of patients’ suffering. Some parts of the APS-SE were not considered useful, and others were perceived as ethically questionable.

Conclusion: Health professionals greatly need an observational pain assessment tool for people with advanced cancer. The APS-SE is helpful in this context, but participants did not perceive it as ideal. Its problems seem inherent to the original APS rather than related to its translation from English to Swedish. Further research is needed to provide a more suitable pain assessment tool for patients with advanced cancer.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Abbey Pain Scale, Cancer, End-of-life care, Pain assessment, Palliative care, Qualitative content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206951 (URN)10.1186/s12912-023-01227-7 (DOI)000962672100002 ()2-s2.0-85152708199 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland, AMP 18-922Region Västerbotten, 7003533
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2024-04-30Bibliographically approved
3. The Abbey Pain Scale: not sufficiently valid or reliable for assessing pain in patients with advanced cancer
Open this publication in new window or tab >>The Abbey Pain Scale: not sufficiently valid or reliable for assessing pain in patients with advanced cancer
2023 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 62, no 8, p. 953-960Article in journal (Refereed) Published
Abstract [en]

Background: Patients with advanced cancer can be unable to verbalize their pain. The Abbey Pain Scale (APS), an observational tool, is used to assess pain in this setting, but has never been psychometrically tested for people with cancer. The aim of this study was to assess the validity, reliability, and the responsiveness of the APS to opioids for patients with advanced cancer in a palliative oncology care setting.

Material and Methods: Patients with advanced cancer and poor performance status, drowsiness, unconsciousness, or delirium, were assessed for pain using a Swedish translation of the APS (APS-SE) and, if possible, the Numeric Rating Scale (NRS). The assessments using APS were conducted simultaneously, but independently, by the same raters on two separate occasions, approximately one hour apart. Criterion validity was assessed by comparing the APS and NRS values using Cohen’s kappa (κ). Inter-rater reliability was determined using the intraclass correlation coefficient (ICC), internal consistency using Cronbach’s α, and responsiveness to opioids using the Wilcoxon signed-rank test.

Results: Seventy-two patients were included, of whom n = 45 could rate their pain using the NRS. The APS did not detect any of the n = 22 cases of moderate or severe pain self-reported using the NRS. The APS at first assessment had a κ of 0.08 (CI: −0.06 to 0.22) for criterion validity, an ICC of 0.64 (CI: 0.43–0.78) for inter-rater reliability, and a Cronbach’s α of 0.01 for internal consistency. The responsiveness to opioids was z = −2.53 (p = 0.01).

Conclusion: The APS was responsive to opioids but displayed insufficient validity and reliability and did not detect moderate or severe pain as indicated by the NRS. The study showed a very limited clinical use of the APS in patients with advanced cancer.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Abbey Pain Scale, cancer, Pain assessment, reliability, responsiveness, validity
National Category
Nursing Physiotherapy
Identifiers
urn:nbn:se:umu:diva-212109 (URN)10.1080/0284186X.2023.2228992 (DOI)001019893100001 ()37382384 (PubMedID)2-s2.0-85163716000 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland, 18-922Västerbotten County Council, 7003533
Available from: 2023-07-17 Created: 2023-07-17 Last updated: 2024-04-30Bibliographically approved

Open Access in DiVA

fulltext(1023 kB)20 downloads
File information
File name FULLTEXT01.pdfFile size 1023 kBChecksum SHA-512
bc7a89d96f6b541d0882ec9116727279d0a46953307696f48598d1f75e0a1fd5b0a1234ce27948953783583151da0d181562038ab27e736bcb33b7d8be0914bc
Type fulltextMimetype application/pdf
spikblad(108 kB)16 downloads
File information
File name SPIKBLAD02.pdfFile size 108 kBChecksum SHA-512
1a8754ad6060f0857bed79786cf4a51b6535e4e7bf3e000eabbe1de6b1245c907eaeba98aecadbfccbc7ea13076b65c8693f4ac7c063fae9d699b930ead8d09e
Type spikbladMimetype application/pdf

Authority records

Tegenborg, Sussi

Search in DiVA

By author/editor
Tegenborg, Sussi
By organisation
Department of Diagnostics and Intervention
Cancer and OncologyNursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 20 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 266 hits
1213141516171815 of 18
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf