title: Psychometric Evaluation of the Pain Attitudes Questionnaire-Revised for People With Advanced Cancer.
abstract: Pain-related stoicism and cautiousness are theorized to be more prevalent in older than younger patients and to lead to greater pain under-reporting and consequently inadequate pain management in older patients. The Pain Attitudes Questionnaire-Revised (PAQ-R), which measures 5 pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) factors in chronic pain, can help test this hypothesis in advanced cancer but requires validation. We conducted a psychometric evaluation of the PAQ-R in 155 younger (younger than 60 years) and 114 older (aged 60 years and older) patients with advanced cancer. Participants showed disagreement with self-doubt items and floor effects with the subscale. Confirmatory factor analyses revealed good fit of the PAQ-R's 5 factors to younger and older groups' data but collinearity between fortitude and concealment. Multisample confirmatory factor analyses supported partial scalar invariance between age groups. Few hypothesized age-related differences were observed. Younger patients reported higher superiority scores than older patients. Whereas older patients showed greater fortitude and superiority with lower average pain intensity, younger patients showed greater concealment or fortitude with greater worst and average pain intensity. Furthermore, whereas older patients displayed greater superiority with lower interference in relations with others, younger patients displayed greater concealment and superiority with greater interference in walking ability and greater concealment and self-doubt with more interference in relations with others. Cross-validation of the PAQ-R's factor structure and identification of pathways to the factors and effect on pain-related outcomes using multivariate approaches are warranted.
  
  
  
  This article presents the psychometric properties of a measure of 2 particular pain-related attitudes. The measure can help clarify whether these attitudes adversely influence pain reporting in older patients with advanced cancer as hypothesized and, in turn, explain the inadequate pain management frequently reported with this clinical group.
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mah
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; University College Dublin, Dublin, Ireland.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Tran
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada.
authors.forename: Lynn R
authors.initials: LR
authors.lastname: Gauthier
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Warr
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: S Lawrence
authors.initials: SL
authors.lastname: Librach
authors.affiliation: British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: gagliese@yorku.ca.
authors.forename: Lucia
authors.initials: L
authors.lastname: Gagliese
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072716:Cancer Pain / Q000209:etiology / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010147:Pain Measurement / Q000592:standards*; D010684:Philosophy; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards; D055815:Young Adult
keywords: Advanced cancer; attitudes; cancer pain; older people; psychometric evaluation