Development Of Chinese Version Of Combined Pain Assessment System For Children With Cancer And Research On Influencing Factors Of Pain Interference

ObjectivesPain is an important influencing factor of quality of life among children with cancer.Accurate pain assessment is a key part of pain management.However,it is difficult for existing pain assessment tools to depict a complete “image” of pain.This study introduced Cancer Child Pain Assessment System(Pain Squad)from Canada,in order to develop a comprehensive pain assessment tool for children with cancer and complete a metrics test of it.On the basis of this,research data of children with cancer children from first-class ternary hospitals in Shanghai obtained by the combined pain assessment system was analysed under the guidance of theory of unpleasant symptoms.Then,a complete picture of cancer children's pain experience was presented,thus to provide a realistic basis for optimizing the comprehensive intervention strategy of pain management among children with cancer.Methods1.Development of a Chinese version of combined pain assessment system for children with cancer: After introducing Cancer Child Pain Assessment System(Pain Squad)from Canada,translation of it started by using International standardization of chronic disease treatment function evaluation(FACIT)translation method.With 9 steps of translation,reconciliation,back-translation,back-translation evaluation,expert review and proofreading,Canadian Pain Squad research and development team's quality evaluation,cognitive interview,expert consultation and content determination,final evaluation,a Chinese version of combined pain assessment system for children with cancer was established.2.Metrics test of the Chinese version of combined pain assessment system for children with cancer: By convenience sampling,demographic and disease-related questionnaires,the Chinese version of the combined pain assessment system and Pain Interference Short Form of the Chinese Version-Pediatric Patient-reported Outcomes Measurement Information System(PROMIS)including child and parental editions were used to conduct a survey on 275 cancer children.Reliability and validity analysis were conducted using item hierarchical cluster analysis,content validity index,Cronbach's alpha coefficients and Pearson correlation coefficients.3.Cross section study of cancer children's pain experience and study of influencing factors of pain intergerence: Based on the theory of unpleasant symptoms,the Depression,Anger,Anxiety,Fatigue,Peer Relationship,Physical Function-Mobility and Physical Function-Upper Extremity Function Short Form(child and parental editions)of PROMIS was used as a supplemental tool to conduct the survey among the above 275 cancer children on multi-layers such as physical,psychological,social support,behavioral performance,and other negative symptoms.Descriptive analysis was used to present the status of pain experience.Pearson correlation analysis and one-way analysis of variance(ANOVA)were used to analyze the interactions between multi-layers of pain experience.Influencing factors of pain interference was further analyzed using multiple linear regression analysis.Results1.System Development: According to the translation standard,Canadian Pain Squad team approved the Chinese version of Pain Assessment System for further use.The system includes child and caregiver editions,each containing 20 items,1 instructional question,and 1 supplementary question.2.Metrics test of system: According to the results of cluster analysis of items,professional judgment and theory of unpleasant symptoms,the system is divided into four dimensions: pain intensity,pain duration,pain interference,and pain characteristics.The face validity and content validity(CVI are all 1,the importance level of each item is 75%-100%,the Pearson correlation coefficients between each item and its dimension are 0.683-0.933),and the criterion-related validity(Pearson's correlation coefficient between total scores of different pain interference assessment tools was 0.606-0.723)and the reliability(Cronbach's alpha coefficients were 0.806-0.953,Guttman's split-half coefficients were 0.772-0.828)was good.3.Current status and influencing factors studies:(1)Current status of pain experience: The survey results of 275 cancer children from 4 first-class ternary hospitals in Shanghai showed that:(1)The incidence of moderate to severe pain is 60.3%;Acute or paroxysmal pain was the most common(50.5%).However,chronic pain remains a high proportion(12.7%)and should not be ignored.Cance,its treatment and medical operations are the main causes of pain.The incidence of single-site pain is highest(59.6%).The total score of pain interference was 28.81±19.87 point,and the overall level is moderate.Some children have extreme pain experiences(such as unbearable 29 cases(10.5%)).Those with inadequate pain control still account for a high proportion(26.2%),and there is not enough support for professional therapy to release pain such as psychotherapy.Its use rate was only 9.4%.Fatigue was the main concomitant symptom(67.3%).Depression,anger,and anxiety had a high incidence of 64.2%,64.0%,70.5% separately.Peer relationship,Physical Function-Mobility and Physical Function-Upper Extremity Function of behaviorally limited performance also had a high incidence of 71.7%,71.7%,53.6% respectively.At the same time,due to research bias,the situation above may be underestimated.(2)Pain intensity,pain duration,pain interference and pain control were affected by different factors of other pain manifestations,physical,psychological,social support,function,and other negative symptoms(P<0.05).(2)Influencing factors of pain interference: low intensity of worst pain,low fatigue level,low intensity of pain right now,high reimbursement rate of medical expenses,pain due to reasons other than cancer,good mobility function,low intensity of least pain and treatment status other than perioperative period are of important predictors of low pain interference,which can explain 64.1% of the variation in pain interference.Among that,intensity of worst e pain has the greatest effective size on pain interference.Conclusion1.The Chinese version of combined pain assessment system for children with cancer developed in this study has a good reliability and validity,thus can be used for pain assessment among children with cancer in China.2.All aspects of cancer children's pain manifestations need to be improved.Negative symptoms such as fatigue often accompany.Most of them are at negative psychological status such as depression,anger and anxiety,and with limited peer relationship,mobility and upper extremity function.3.The impair pain manifestations of cancer children is the result of multiple influences including physical,psychological,social support,functions and other negative symptoms.There are still interactions between various factors of pain manifestations.All above indicates that pain of children with cancer is different from other symptoms.Its complexity determines the requirement of a multi-dimensional,comprehensive pain assessment system in order to depict a complete "image" of pain.4.The level of pain interference in children with cancer in China is higher than that in foreign countries.Clinical assessment should be conducted in time especially during the perioperative period,focusing on intensity of worst pain,taking effective measures to reduce fatigue,focusing on cancer pain treatment and improving mobility function.