Open Access Open Access  Restricted Access Subscription or Fee Access

Comprehensibility and readability of patient self-administered Opioid Assessment Screening Tools

Lorraine S. Wallace, PhD, Amy J. Keenum, PharmD, DO, Steven E. Roskos, MD

Abstract


Objective: The aims of this study were to evaluate the cognitive complexity and reading demands of patient self-administered Opioid Assessment Screening Tools (OASTs) for use in adults with nonmalignant pain.
Methods: Using comprehensive search strategies, we identified english-language OASTs with established validity and reliability for inclusion in our study. Cognitive complexity of individual OAST statements or questions were assessed using three techniques (number of items, number of words, and linguistic problems), whereas readability was measured using the Flesch- Kinkaid formula.
Results: Four (n = 4) were identified and included in our review: Current Opioid Misuse Measure (COMM), Pain Medication Questionnaire (PMQ), Screener and Opioid Assessment for Patient with Pain, and Screening Tool for Addiction Risk (STAR). Number of total OAST statements or questions ranged from a low of 14 (STAR) to a high of 26 (PMQ), whereas number of words (length) per statement or question averaged from a low of 10.2 ± 1.1 (STAR) to a high of 15.9 ± 3.8 (PMQ). The STAR (1.3 ± 1.1) had the fewest number of linguistic problems per statement or question, whereas the PMQ (3.0 ± 1.4) had the most linguistic problems per statement or question. Although, readability of OASTs ranged from approximately sixth (STAR) to eighth (COMM, PMQ) grade, there was notable variation in readability across individual statements or questions.
Conclusions: Our study demonstrates that formatting characteristics, including linguistic problems, and high readability of several OAST statements or questions may hinder many patients’ ability to accurately complete and comprehend OASTs independently.

Keywords


aberrant drug behaviors, addiction, assessment, chronic pain, opioids, screening

Full Text:

PDF

References


Portenoy RK, Ugarte C, Fuller I, Haas G: Population-based survey of pain in the United States: Differences among white, African American, and Hispanic subjects. J Pain. 2004; 5: 317-328.

Mallen C, Peat G, Thomas E, Croft PR: Severely disabling chronic pain in young adults: Prevalence from a populationbased postal survey in North Staffordshire. BMC Musculoskelet Disord. 2005; 21: 42-47.

Reyes-Gibby CC, Aday LA, Todd KH, Cleeland CS, Anderson KO: Pain in aging community dwelling adults in the United States: Non-Hispanic whites, non-Hispanic blacks, and Hispanics. J Pain. 2007; 8: 75-84.

Davis MP, Lasheen W, Gamier P: Practical guide to opioids and their complications in managing cancer pain. What oncologists needs to know. Oncology (Williston Park). 2007; 21: 1229-1238.

Hojsted J, Sjogren P. Addiction to opioids in chronic pain patients: A literature review. Eur J Pain. 2007; 11: 490-518.

Ponte CD, Johnson-Tribino J: Attitudes and knowledge about pain: An assessment of West Virginia family physicians. Fam Med. 2005; 37: 477-480.

Potter M, Schafer S, Gonzalez-Mendez E, et al.: Opioids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford collaborative research network. J Fam Pract. 2001; 50: 145-151.

Scanlon MN, Chugh U: Exploring physicians’ comfort level with opioids for chronic noncancer pain. Pain Res Manag. 2004; 9: 195-201.

Devulder J, Richarz U, Nataraja SH: Impact of long-term use of opioids on quality of life in patients with chronic, non-malignant pain. Curr Med Res Opin. 2005; 21: 1555-1568.

Simon S: Opioids and treatment of chronic pain: Understanding pain patterns and the role for rapid-onset opioids. MedGenMed. 2005; 23: 54.

Michna E, Ross EL, Hynes WL, et al.: Predicting abrerrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manag. 2004; 28: 250-258.

Compton P, Darakjian J, Miotto K: Screening for addiction in patients with chronic pain and “problematic” substance use: Evaluation of a pilot assessment tool. J Pain Symptom Manag. 1998; 16: 355-363.

Passik SD, Kirsh KL, Whitcomb L, et al.: A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004; 26: 552-561.

Passik SD, Kirsh KL, Whitcomb L, et al.: Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the pain assessment and documentation tool. J Opioid Manag. 2005; 1: 257-266.

Wu SM, Compton P, Bolus R, et al.: The addiction behaviors checklist: Validation of a new clinician-based measure of inappropriate opioid use in chronic pain. J Pain Symptom Manag. 2006; 32: 342-351.

Wallace LS, Lennon ES: American Academy of Family Physicians patient education materials: Can patients read them? Fam Med. 2004; 36: 571-574.

Griffin J, McKenna K, Tooth L: Discrepancy between older clients’ ability to read and comprehend and the reading level of written educational materials used by occupational therapists. Am J Occup Ther. 2006; 60: 70-80.

Wallace LS, Roskos SE, Weiss BD: Readability characteristics of consumer medication for asthma inhalation devices. J Asthma. 2006; 43: 375-378.

Wolf MS, Davis TC, Shrank WH, et al.: A critical review of FDA-approved medication guides. Patient Educ Couns. 2006; 62: 316-322.

Davis TC, Wolf MS, Bass BP, et al.: Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006; 145: 887-894.

Paasche-Orlow M, Taylor H, Brancati F: Readability standards for informed-consent as compared with actual readability. N Engl J Med. 2003; 348: 721-726.

Roskos SE, Keenum AJ, Newman LM, Wallace LS: Literacy demands and formatting characteristics of opioid contracts in chronic nonmalignant pain management. J Pain. 2007; 8: 753-758.

National Center for Education Statistics: National Assessment of Adult Literacy. A First Look at the Literacy of America’s Adults in the 21st Century. Washington, DC: National Center for Education Statistics Publication No. 2006470.

Graesser AC, Cai Z, Louwerse MM, Daniel F: Question understanding aid (QUAID): A web facility that tests question comprehensibility. Pub Opin Quart. 2006; 70: 3-22.

Graesser AC, Wiemer-Hastings K, Kreuz R, et al.: QUAID: A questionnaire evaluation aid for survey methodologists. Behav Res Methods Instrum Comput. 2000; 32: 254-262.

Bar E, Casado A, Garc-a-Cases C, Clerch L, Ribas S: Assessing satisfaction with pain medication in primary care patients: Development and psychometric validation of a new measure. Clin Ther. 2004; 26: 1124-1136.

Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005; 6: 432-442.

Schieffer BM, Pham Q, Labus J, et al.: Pain medication beliefs and medication misuse in chronic pain. J Pain. 2005; 6: 620-629.

Coambs RB, Jarry JL, Santhiapillai AC, et al.: The SISAP: A new screening instrument for identifying potential opioid abusers in the management of chronic nonmalignant pain within general medical practice. Pain Res Manag. 1996; 1: 155-162.

Butler SF, Budman SH, Fernandez KC, et al.: Development and validation of the Current Opioid Misuse Measure. Pain. 2007; 130: 144-156.

Adams LL, Gatchel RJ, Robinson RC, et al.: Development of a self-report screening instrument for assessing opioid medication misuse in chronic pain patients. J Pain Symptom Manag. 2004; 27: 440-459.

Holmes CP, Gatchel RJ, Adams LL, et al.: An opioid screening instrument: Long-term evaluation of the utility of the Pain Medication Questionnaire. Pain Pract. 2006; 6: 74-88.

Butler SF, Budman SH, Fernandez K, Jameson RN: Validation of a screener and opioid assessment measure for patients with chronic pain. Pain. 2004; 112: 65-75.

Akbik H, Butler SF, Budman SH, et al.: Validation and clinical application of the screener and opioid assessment for patients with pain (SOAPP). J Pain Symptom Manag. 2006; 32: 287-293.

Friedman R, Li V, Mehrotra D: Treating patients at risk: Evaluation of a screening tool in opioid-treated pain patients with and without addiction. Pain Med. 2003; 4: 182-185.

Shumway M, Sentell T, Unick G, Bamberg W: Cognitive complexity of self-administered depression measures. J Affect Disord. 2004; 83: 191-198.

Flesch R: A new readability yardstick. J Appl Pychol. 1948; 32: 221-233.

Paolo AM, Ryan JJ, Dunn GE, Van Fleet J: Reading grade level of the dissociative experiences scale. J Clin Psychol. 1993; 49: 209-211.

Beckman HT, Lueger RJ: Readability of self-report clinical outcome measures. J Clin Psychol. 1997; 53: 785-789.

Calderon JL, Morales LS, Liu H, Hays RD: Variation in the readability of items within surveys. Am J Med Qual. 2006; 21: 49-56.

Neilsen-Bohlman L, Panzer AM, Kindig DA (eds.): Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press, 2004.

Weiss BD: Epidemiology of low health literacy. In Schwartzberg JG, VanGest JB, Wang CC (eds.): Understanding Health Literacy. Chicago, IL: American Medical Association, 2005: 17-39.




DOI: https://doi.org/10.5055/jom.2007.0023

Refbacks

  • There are currently no refbacks.