title: Psychometric properties of a brief, clinically relevant measure of pain in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Due to diagnosis at advanced stages, comorbidities, and the impact of treatment, patients with hepatocellular carcinoma (HCC) may experience pain. The purpose of this study was to evaluate the psychometric properties of a brief, clinically relevant measure of pain in HCC.
  
  
  METHODS
  We conducted a secondary data analysis from four longitudinal studies of patients with HCC (total n = 304). All patients completed the FACT-Hepatobiliary (FACT-Hep) questionnaire, and 49 patients completed the Brief Pain Inventory (BPI) Interference scale. We conducted confirmatory factor analysis (CFA), Rasch modeling, and correlational analysis to assess the psychometrics of the three items on the FACT-Hep that assess HCC-relevant pain scale.
  
  
  RESULTS
  Patients had an average age of 63.5 (±12.2) and were mostly male (76 %). The mean three-item pain subscale score was 8.5 ± 3.0. Seventy-four (24.3 %) patients reported no pain (score = 12). Results of a one-factor CFA supported unidimensionality of the items, and all items fit the Rasch model. An item-person map demonstrated that the three items covered all patients with non-extreme scores. Pain scores were significantly associated with baseline general health-related quality of life (FACT-General, r = 0.60, p < 0.001) and pain interference (BPI, r = -0.63, p < 0.001).
  
  
  CONCLUSIONS
  The three FACT-Hep pain items are unidimensional, cover the range of pain experienced by most patients with HCC, and demonstrate convergent validity. This pain subscale is, if future research demonstrates its sensitivity to change, potentially useful for HCC clinical trials.
authors.affiliation: Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, 19th Floor, Chicago, IL, 60611, USA, z-butt@northwestern.edu.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Butt
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.forename: Karen
authors.initials: K
authors.lastname: Kaiser
authors.forename: Rajiv
authors.initials: R
authors.lastname: Mallick
authors.forename: David
authors.initials: D
authors.lastname: Cella
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010146:Pain / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods*; D011594:Psychometrics / Q000706:statistics & numerical data; D011788:Quality of Life; D011795:Surveys and Questionnaires / Q000592:standards*
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