Indigenous Study Of Assessment Tools In The COSTaRS Cancer Pain Practice Guideline And Its Application

Objective:Based on the Chinese contexts,to introduce the Pain Practice Guide and its 5 outcome measurement instruments(Baseline Barriers Survey,The CPD Questionnaire,Patient Satisfaction Survey,Training Evaluation Survey and Chart Audit Tool)of the pan-Canadian Oncology Symptom Triage and Remote Support(COSTaRS)Project,by cross-cultural adaptation and localization,to make it suitable for China's national conditions and clinical contexts.The CPD Questionnaire is simple and convenient with clear dimensions.The results of the 12 item are all quantifiable indicators.It can be used to evaluate the effects of participating in CPD activities on clinical practice.It has a wide range of applications.After cross-cultural adaptation,a formal investigation will be carried out to test its reliability and validity,to provide high-quality tools for further research on cancer pain remote management and the effects of CPD activities.Methods:This study uses the Knowledge to Action Framework(KTA)as the theoretical framework to conduct the localization research of the COSTaRS Pain Practice Guide and its outcome measurement instruments.1.Cross-cultural adaptation of COSTaRS Pain Practice Guide and its outcome measurement instruments:According to the cross-cultural adaptation guidelines put forward by the American Academy of Orthopedic Surgeons Evidence Based Medicine Committee(AAOS),through 4 steps:translation,synthesis,back translation and expert committee review to conduct cross-cultural adaptation of the COSTaRS Pain Practice Guide and its outcome measurement instruments,and use the CPD Questionnaire reviewed by experts to conduct a pretest in 20 clinical nurses,modify the CPD Questionnaire based on the feedback from the pretest,and form the final questionnaire.2.Adaptation of COSTaRS Pain Practice Guide:Using the core phases and steps of ADAPTE Resource toolkit V2 proposed by the ADAPTE Collaboration to adapt the COSTaRS Pain Practice Guide.This study selectively uses the 3 stages and 15 steps of the ADAPTE methods to adapt the guide.3.Reliability and validity test of CPD Questionnaire:use the CPD Questionnaire to conduct formal surveys,use purposive sampling,a combination of online and offline methods to survey 223 clinical nurses,use Microsoft Excel 2019 for data entry,SPSS 25.0 and Amos 26.0 for descriptive statistics and analysis of reliability and validity.Reliability analysis uses coefficient of internal consistency and reliability of retest after 2 weeks.Validity analysis uses Delphi method to evaluate content validity and confirmatory factor analysis(CFA)to evaluate structure validity and convergent validity.Results:1.The cross-cultural adapted COSTaRS Pain Practice Guide and its outcome measurement instruments are easy to understand,and are in line with Chinese culture and clinical contexts.Five experts participated in the expert committee review.The overall coefficient of authority was 0.82,and the personal coefficient of authority ranged from 0.67 to 0.90.The expert committee review results indicate that the guide is clear,concise and convenient,and can evaluate pain symptom and give cancer pain patients recommendations within 10-15 minutes,which is convenient for clinical use.Its outcome measurement instruments are easy to understand,and their contents can be adapted according to the purpose of research,which have a wide range of application.2.The COSTaRS Pain Practice Guide was adapted by the ADAPTE methods,and the AGREE II instrument was used to evaluate the quality of the guide.The guide currency,acceptability and applicability of the recommendations was evaluated by the ADAPTE Resource Toolkit V2.The results were good.The inclusion of recommendations was determined by the expert demonstration meeting.The personal coefficient of authority of the 9 experts ranged from 0.77 to 1.00,and the overall coefficient of authority was 0.83,indicating that the expert demonstration results were reliable.The adapted guide "Pain Practice Guide for the Management of Pain in Adult Cancer Patients" was formed,and external review-target audience of the guide,plan for aftercare of the adapted guide were carried out.The results showed that medical staff had a high degree of recognition of this guide and recognized the necessity of the development of it.The recommendations of this guide are clear,do more good than harm and have a wide range of application.It should be approved as a practice guide for clinical practice.However,a certain amount of human resources and financial resources are required for its application,and the current clinical symptom management practice needs to be changed.3.The Chinese version of CPD Questionnaire is easy to understand.The majority of nurses can complete the questionnaire within 2-5 minutes.The effective recovery rate of the questionnaire is 94.62%.The CFA analysis model shows that the fit is good and ideal.IFI,CFI,NFI,TLI are all>0.9,which fit well.The 5 dimensions:intention,social influence,belief about capabilities,moral norm and beliefs about consequences,each factor loading corresponding to latent variable is greater than 0.8,each item corresponding to latent variable is highly representative.The AVE of each latent variable is all>0.7,and the CRs are all>0.8,which means the convergent validity is ideal;the overall Cronbach's a coefficient of the questionnaire is 0.942,and the Cronbach's a coefficient of 5 dimensions ranged from 0.718 to 0.867,which means the internal consistency of the questionnaireis good;After 2 weeks,20 nurses were randomly selected to recomplete the CPD Questionnaire,and the retest reliability was good.Conclusion:1.The cross-cultural adaptation of the COSTaRS Pain Practice Guide and its outcome measurement instruments follow the scientific and rigorous cross-cultural adaptation guideline put forward by the AAOS.After the adaptation,they conform to Chinese culture and clinical contexts,have good acceptability and feasibility.2.The adaptation of the COSTaRS Pain Practice Guide follows the scientific and rigorous ADAPTE methods.The adapted "Pain Practice Guide for the Management of Pain in Adult Cancer Patients" has a clear structure,is user-friendly,and provides relevant tools needed in the application,which can help China explore the remote management model of cancer pain and other symptoms.3.The Chinese version of the CPD Questionnaire has good acceptability and feasibility,good reliability and validity.It can be used to assess the effects of participating in CPD activities on clinical practice behavior.At the same time,the items of the CPD Questionnaire can be adapted for specific purposes,which has a wide range of applications.