Pain Assessment Recommendations for Women, Made by Women: A Mixed Methods Study.

Abstract

To quantitatively describe women's priorities for pain assessment and qualitatively explain unique features of women's pain experiences. Mixed-methods study that included a three-round Delphi study followed by in-depth interviews. Clinical research study. Twenty-three women with chronic pain recruited from three women's pain treatment facilities and one interdisciplinary chronic pain clinic. Phase 1 (Delphi) involved completion of a questionnaire that rated agreement with the importance of 32 commonly used pain assessment measures. Answers were compiled, and controlled feedback was provided after each round. This iterative process continued until acceptable stability was reached. Stability was defined as proportion agreement for each response that reached the a priori cutoff score of 75%. Phase 2 (qualitative) involved one-to-one telephone interviews that followed a semistructured interview guide partially informed from phase 1 findings. A descriptive approach summarized and described participants' perspectives while avoiding abstractions. Textual data were analyzed using content analysis. Phase 1 identified 15 pain assessments as important. Some commonly used pain assessment measures such as the numeric pain intensity rating scale did not reach agreement as important. However, no pain assessments reached agreement as unimportant. Ten additional women completed face-to-face interviews, and an overall theme of stigmatization emerged that highlighted the importance of soliciting the pain narrative and why some aspects of psychosocial pain assessment did not reach agreement. Priorities identified by women for the assessment of pain were largely consistent with expert recommendations; however, important differences were raised that merit consideration for clinicians to reduce stigma.