Highlights
- •The Pain Attitudes Questionnaire-Revised is valid for use in advanced cancer.
- •Older patients were not more stoic or cautious than younger patients about pain.
- •Younger patients reported greater stoic-superiority than older patients.
- •Stoicism–pain correlations differed in direction between age groups.
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: March 04, 2017
Accepted:
February 21,
2017
Received in revised form:
December 2,
2016
Received:
June 22,
2016
Footnotes
K.M. and K.T.T. contributed equally to this work and should be regarded as co-first authors.
Current address for Lynn R. Gauthier: Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval; l’Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, CHU de Québec-Université Laval Research Center; Université Laval Cancer Research Center, Québec, Québec, Canada.
S.L.L. is deceased.
This work was supported by awards from the Canadian Institutes of Health Research (grant number 62866, 2003) and the Canada Foundation for Innovation (2002) to L.G. L.R.G. received Doctoral and Postdoctoral Fellowship funding from the Canadian Cancer Society and the Canadian Breast Cancer Foundation–Ontario Region. These funding sources had no involvement in the study design, the collection, analysis, and interpretation of the data, the writing of the report, and the decision to submit the report for publication.
The authors have no conflicts of interest to declare.
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© 2017 by the American Pain Society
