A preliminary report on the Chinese Cancer Pain Assessment Tool (CCPAT): reliability and validity.

BACKGROUND: This study was to establish the validity and reliability of the Chinese Cancer Pain Assessment Tool (CCPAT) for Chinese patients with cancer pain in Hong Kong. METHODS: It was a quasi-experimental study. The CCPAT was tested for its reliability and validity by 26 cancer pain patients and 26 chronic non-cancer pain patients. McGill Pain Questionnaire (MPQ), with its established reliability and validity, was used as the criterion tool for comparison. RESULTS: An internal consistency of 0.88 and the inter-rater reliability of 0.96 were obtained for the CCPAT. The Spearman's Rho correlations between the functional and emotional dimensions of the CCPAT and the present pain intensity of the MPQ positively correlated. This indicated a satisfactory concurrent validity. Discriminant validity was performed with MANOVA. The CCPAT was able to predict 80.8% of the subjects correctly as cancer pain patient from the cancer pain group. CONCLUSIONS: The constructed CCPAT is a valid and reliable cancer pain assessment tool in a Chinese context. The developed CCPAT is the first of its kind for the Chinese community in Hong Kong. It is anticipated that the results can provide the health care professionals with the best possible instrument and indicator. The CCPAT also lays the theoretical construct for the professionals with a better understanding of the experience of cancer pain from a multidimensional perspective.

The lens model: assessment of cancer pain in a Chinese context.

Obtaining a result closest to patients' reports about pain is crucial in pain management. The literature in the West supports the view that there are cultural differences in perception, interpretation, and expression of pain. However, there has been minimal review in Chinese communities. Therefore, the concepts of cancer pain among Chinese patients with cancer were explored by data source triangulation. There were 33 informants: 18 adult Chinese patients with cancer who were in pain, 7 physicians, and 8 nurses. The interview dialogue was transcribed into written Chinese, followed by coding and categorization. There were no predetermined themes for categorization. The dialogue was coded according to the contextual meaning. The nature and number of categories depended entirely on the coding. Five dimensions were identified: functional, pharmacologic, pain belief and meanings, psychosocial, and emotional. With reference to the five dimensions, a lens model was constructed to explain the cancer pain experience in a Chinese context. In the lens model, two lenses were used to illustrate the relations of the dimensions and cancer pain experience in the Chinese context. The pain experience was named as total pain intensity. The functional, pharmacologic, psychosocial, and emotional dimensions were the independent variables. The pain beliefs and meanings dimension was the mediating variable, and the dependent variable was the total pain intensity in the assessment of cancer pain.

Placental markers of human exposure to polychlorinated dibenzofurans and polychlorinated biphenyls: implications for risk assessment.

In 1979, rice oil accidentally contaminated with a mixture of polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) was ingested by a large number of individuals in Taiwan. Placentas obtained from women four years after the exposure had occurred contained several PCB congeners known to be present in the rice oil as well as two toxic PCDF congeners: 2,3,4,7,8-pentachlorodibenzofuran (2,3,4,7,8-PCDF) and 1,2,3,4,7,8-hexachlorodibenzofuran (1,2,3,4,7,8-HCDF). Placentas from exposed women had markedly elevated activities of two cytochrome P1-450 dependent enzymes, arylhydrocarbon hydroxylase and ethoxyresorufin O-deethylase. The average magnitude of enzyme induction was 100-fold, but much interindividual variation was evident. Binding properties of epidermal growth factor (EGF) to its receptor were not altered by PCB-PCDF exposure. However, EGF-stimulated autophosphorylation of the EGF receptor was decreased significantly in placentas from exposed women and this effect was strongly correlated with decreased birth weight. Species comparisons of effects on EGF receptor actions and cytochrome P-450 isoenzymes, coupled with data on tissue concentrations of PCDFs, suggest that humans are more sensitive than rats to some of the biochemical effects of PCDFs and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The data are discussed in relation to key issues in the risk assessment of the toxic halogenated aromatics.