Assessing Multidimensional Pain in Gero-Oncology: A Clinical Infometrics Approach

描述（由申请人提供）：我们建议开发一个模型驱动的、基于证据的疼痛信息库，用于针对老年肿瘤学患者的疼痛评估。这将建立在我们的新型疼痛评估和干预网络（NoPAIN）项目（Chang， PI, 1R21CA113191-01）的基础上，并继续其临床信息计量学方法。这项拟议的研究是为了响应PA-03-152（生物行为疼痛研究）而设计的，旨在“改进现有的测量疼痛的技术，并开发针对不同人群的疾病和结果的新技术。”我们选择这个人群的疼痛状况是因为：疼痛是一种复杂的多维体验；目前存在大量的疼痛工具，迫切需要改进和实施它们；考虑到社会人口结构，老年人癌症的疼痛管理是一个紧迫的问题。我们还旨在为该题库构建一个计算机化的自适应测试平台：1)能够可靠地测量异质性癌症患者的多维疼痛体验；2)对变化很敏感，因此它可以评估治疗的有效性。我们的四个不同但相关的具体目标是：1)利用生物心理社会医学和姑息治疗的现有理论框架为指导，确定和完善老年肿瘤人群的疼痛评估领域；2)编制多维疼痛题库，从已有的疼痛问卷中提取，补充新编写的疼痛题库；3)经验性开发适用于老年肿瘤人群的疼痛题库；4)初步测试计算机自适应测试（CAT）平台，以在临床环境中管理个性化的疼痛评估。在R21项目结束时，我们期望：(1)老年肿瘤学疼痛测量的概念模型可以得到改进；(2)可以构造疼痛项的初始集；(3)能够识别和修改显示差异项目功能（DIF）的项目；(4) CAT原型将演示如何在临床环境中实施和测试该系统。

DESCRIPTION (provided by applicant): We propose to develop a model-driven, evidence-based pain item bank for use in pain assessment that is specific to geriatric oncology (gero-oncology) patients. This will build on our Novel Pain Assessment and Intervention Network (NoPAIN) project (Chang, PI, 1R21CA113191-01), and continue its Clinical Infometrics approach. This proposed study is designed in response to PA-03-152 (Biobehavioral Pain Research) to "refine existing techniques for measuring pain and develop new techniques that are disease- and outcome- specific for different populations." We have chosen the condition of pain in this population because: pain is a complex multidimensional experience; a critical mass of pain instruments now exist and there is an urgent need to refine and implement them; and pain management in cancer among older adults is a pressing issue given societal demographics. We also aim to construct a computerized adaptive testing platform for this item bank that: 1) can reliably measure the multidimensional pain experience of heterogeneous cancer patients; and 2) is sensitive to change so that it can assess the effectiveness of treatments over time. Our four distinct but related specific aims are: 1) To identify and refine the domains of pain assessment for a gero-oncology population, using existing theoretical frameworks in biopsychosocial medicine and palliative care as a guide; 2) To compile the items for a multidimensional pain item bank, drawing from existing pain questionnaires and supplementing with newly written items; 3) To develop empirically a pain item bank applicable to a gero-oncology population; and 4) To pilot test a computerized adaptive testing (CAT) platform to administer individualized pain assessments in clinical settings. At the end of this R21 project, we expect that (1) the conceptual model of the gero-oncology pain measurement can be improved; (2) the initial sets of pain items can be constructed; (3) items displaying differential item functioning (DIF) can be identified and revised; and (4) the CAT prototype will demonstrate how the system should be implemented and tested in clinical settings.