New ‘Goals for Pain Relief’ Scale Proves Reliable in Pilot Study

SAN DIEGO, California—Patients’ differing goals for pain relief may explain some of the variability in pain outcomes. In an attempt to better understand and document these goals, Marie A. Flannery, RN, MS, a nurse practitioner and senior associate at the University of Rochester Cancer Center, developed a 13-item "goals for pain relief" scale.

The scale was designed to assess patient goals concerning pain severity, pain frequency, pain distress, pain relief, and desired level of pain-related interference with activities. Respondents rated each of the 13 items on an 11-point numeric rating scale.

Responses were prompted with questions such as, What is your goal for how severe you want your pain to be? What is your goal for how distressing or upsetting you want your pain to be today? What is your goal for how much you want your pain to interfere with your general activity? Compared with other goals you have for today, how important is managing your pain?

Ms. Flannery conducted a pilot study of the scale’s reliability in a group of 15 patients with lung, breast, or colon cancer. The patients ranged in age from 48 to 75; 11 were female, and the majority had metastatic disease. All had current prescriptions for opioid analgesics.

The alpha reliability coefficient of the "goals for pain relief" scale was .88, and interitem reliability ranged from .4 to .8. Patients confirmed that the directions and questions on the scale were clear.

This pilot study, presented at a poster session at the Oncology Nursing Society’s 26th Annual Congress (abstract 124), demonstrated a full range of goals for pain relief. However, patient goals were skewed toward a desire for low-level pain, and four patients desired no pain and complete relief in all areas.

Another intriguing finding was a wide variance in patient responses to the question concerning how their goal for pain management compared with their other goals for the day.

Ms. Flannery concluded that the scale has acceptable reliability and is feasible for use in a larger study. She also suggested that the subgroup of patients who desired complete relief could be studied further to determine characteristics that predict different pain-relief barriers.

If goals are found to be an important construct, Ms. Flannery suggested, nursing interventions could be designed to address the clarification and setting of goals in order to improve cancer patients’ outcomes.

The scale currently is being used in a longitudinal study of cancer patients’ goals for pain relief. Goals are being tested as one of four predictors of the association between pain and opioid use. Additional analyses will be done to establish the validity and reliability of the scale when sufficient sample size is reached.