title: Measuring the quality of care related to pain management: a multiple-method approach to instrument development.
abstract: BACKGROUND
  Research to document the effects of nursing on patient outcomes such as pain has been limited by the inability to measure the quality of nursing care effectively.
  
  
  OBJECTIVE
  The purpose of this study was to establish content validity and to evaluate patient understanding of Pain Care Quality (PainCQ) survey items using cognitive interviewing.
  
  
  METHODS
  In the development phase, 101 items representing four constructs were generated from the transcriptions of 33 qualitative interviews conducted with cancer patients in pain. In the judgment phase, items were reviewed systematically by two panels of pain experts. In the final phase, cognitive interviews were conducted with hospitalized cancer patients reporting pain.
  
  
  RESULTS
  Content validity was established if eight of nine (p < .05) experts agreed the item was relevant or very relevant. On the basis of the expert panel review, items were deleted, reworded, and added, and 73 items remained. These items were evaluated by cognitive interviews with 39 hospitalized patients with multiple types of cancer in three states. The mean age was 58.87 years, and 60.5% were women. Most were non-Hispanic White (94.7%), and education varied. On a 0 to 10 scale, worst pain during the past shift averaged 5.24 (SD = 2.43). Participant responses to the PainCQ survey items were summarized for each item using a matrix tool and evaluated in team meetings. Through an iterative process, items were revised and reduced to produce the PainCQ survey (v3) with 44 items.
  
  
  CONCLUSIONS
  Through this deliberative and iterative process, an instrument was produced that will contribute to the measurement of the quality of nursing and interdisciplinary care related to pain management. The items retained in the PainCQ were understood and judged by hospitalized patients with pain easily. Further psychometric testing of the PainCQ is indicated.
authors.affiliation: College of Nursing, University of Utah, Salt Lake City, UT 84112-5880, USA. Susan.beck@nurs.utah.edu
authors.forename: Susan Larsen
authors.initials: SL
authors.lastname: Beck
authors.forename: Gail L
authors.initials: GL
authors.lastname: Towsley
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Berry
authors.forename: Jeannine M
authors.initials: JM
authors.lastname: Brant
authors.forename: Ellen M Lavoie
authors.initials: EM
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000451:nursing*; D009859:Oncology Nursing / Q000379:methods*; D010146:Pain / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D010147:Pain Measurement / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D016730:Program Development / Q000379:methods; D011594:Psychometrics / Q000379:methods; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*