Development and validation of the Treatment Expectations in Chronic Pain Scale.

OBJECTIVES: To develop and examine the psychometric properties of the Treatment Expectations in Chronic Pain (TEC) scale, a brief measure of treatment expectations of chronic non-cancer pain treatment. DESIGN: A cross-sectional study design was used. METHODS: After conducting a literature review and expert discussions, a preliminary version of the TEC scale was developed. Cognitive interviews with 10 clinicians and 14 patients were conducted to examine the scale's face validity and item wording. Last, two hundred and five patients on the waitlist for a multidisciplinary pain treatment centre completed a battery of self-report questionnaires to examine the TEC scale's reliability and construct validity. Mokken scale analysis was conducted to select the final items. Reliability (Cronbach's alpha and Guttman's lambda2 ) and construct validity (Pearson correlations) were assessed. RESULTS: The final scale was composed of nine items that each measured ideal and predicted expectations about process and outcome of treatment. Mokken scale analysis showed the presence of two subscales: ideal and predicted expectations. The TEC scale had good internal consistency (α = 0.876-0.869) and adequate discriminant validity as assessed by its low correlation with measures of depression, anxiety, and quality of life (r = -.038 to .114). The scale had however low correlation with a theoretically related measure of optimism (r = .240). CONCLUSION: The TEC scale is a reliable scale measuring pain treatment expectation. Further evaluation of its psychometric properties is needed. The scale has the potential to deepen our understanding of the role treatment expectations play in chronic non-cancer pain treatment response. Statement of contribution What is already known on this subject? Expectations play a role in pain perception and the response to pain treatment Patients' expectations about pain and its management are associated with treatment satisfaction The absence of a validated tool to measure treatment expectations in chronic non-cancer pain prevents further exploration and understanding of the role of expectations in the context of multidisciplinary pain treatment . What does this study add? A new, reliable 9-item scale measuring treatment expectations among chronic non-cancer pain patients attending specialized multidisciplinary pain clinics .

A National Needs Assessment of Canadian Nurse Practitioners Regarding Cannabis for Therapeutic Purposes.

Introduction: In Canada, the Access to Cannabis for Medical Purposes Regulations (ACMPR) has given nurse practitioners (NPs) the power to authorize cannabis for therapeutic purposes (CTP) to eligible patients. This expansion in NPs' scope of practice underscores the importance of delivering balanced, evidence-based education on cannabis to NPs. The aim of this national study was to assess NPs' knowledge and practice gaps related to CTP to inform the development of future education resources that increase NPs' clinical competence and improve patient care related to medical cannabis. Methods: This is a quantitative, descriptive exploratory design study. A national online survey of NPs was conducted from August 2013 to June 2014. NPs were recruited through email lists held by numerous Canadian nursing organizations. The survey was adapted from a previous national survey that assessed CTP educational needs among Canadian physicians. The survey assessed NPs' knowledge, experience, barriers, and attitudes related to CTP as well as preferred format for future CTP education. Results: The sample consisted of 182 NPs from across Canada. The largest knowledge gap was related to dosing and creating effective treatment plans for patients using CTP. The majority of respondents (76.3%) ranked the need for education on CTP to be either strong or very strong. Over half (57%) reported that they would be comfortable authorizing medical cannabis through the ACMPR; this number increased to 64% if they were to receive appropriate education. Conclusion: Nursing regulatory organizations, in partnership with academic institutions and government agencies, must work toward the development of educational and clinical competencies specific to CTP. Tailored education programs are needed to address the knowledge gaps held by NPs and the clinical barriers they face to including CTP as part of their care.

Triage processes at multidisciplinary chronic pain clinics: An international review of current procedures.

Background: Multidisciplinary pain clinics are considered the gold standard for the treatment of chronic pain, yet access to such clinics is difficult and patients' conditions deteriorate while waiting. Instituting a triage process is one way of reducing wait time for some patients and ensuring optimal access given the limited resources available. Surprisingly, there are no established guidelines on how to optimally triage chronic pain patients at tertiary multidisciplinary pain clinics. Aims: The goal of this study was to gather information regarding existing triage systems in multidisciplinary chronic pain clinics worldwide as an initial step toward establishing a definitive evidence-based set of triage guidelines. Methods: A total of 66 multidisciplinary pain clinics worldwide completed an online survey detailing current triage practices at their clinic. The survey was distributed via international and national pain associations. Results: Results showed that the vast majority of multidisciplinary pain clinics (94%) use a triage system, yet many difficulties with these systems have been identified (time requirement, administrative burden, lack of control over scheduling, missing high-priority patients, and prioritizing low-priority patients). The level of satisfaction was noted to be higher in those clinics using a structured triage template. Conclusions: This study identified a need for the elaboration of best practice clinical guidelines for triage processes at tertiary pain clinics. The use of a structured referral template could become a central element to such guidelines.

Contexte: Les cliniques multidisciplinaires de la douleur sont considérées comme l'exemple idéal pour le traitement de la douleur chronique. L'accès à ces cliniques est toutefois difficile, de sorte que l'état de santé des patients se détériore pendant la période d'attente. L'instauration d'un processus de triage est l'une des façons de réduire le temps d'attente pour certains patients et d'assurer un accès optimal aux ressources limitées qui sont disponibles.Objectifs: Le but de cette étude était de recueillir de l'information concernant les systèmes de triage existants dans les cliniques multidisciplinaires de la douleur à travers le monde, comme première étape vers l'établissement de lignes directrices définitives fondées sur des données probantes.Méthodes: Au total, 66 cliniques multidisciplinaires de la douleur à travers le monde ont répondu à un sondage en ligne portant sur les pratiques de triage dans leur clinique. Le sondage a été distribué par l'entremise d'associations nationales et internationales de la douleur.Résultats: Les résultats ont démontré que la vaste majorité des cliniques multidisciplinaires de la douleur (94 %) utilisent un système de triage. Toutefois, de nombreuses difficultés ont été recensées en lien avec ces systèmes (temps nécessaire, fardeau administratif, manque de contrôle sur la prise de rendez-vous, difficulté à identifier certains patients prioritaires et priorisation des patients non prioritaires). Le niveau de satisfaction était plus élevé dans les cliniques qui utilisaient un modèle de référence structuré pour le triage.Conclusions: Cette étude a mis en évidence la nécessité d'élaborer des lignes directrices cliniques indiquant les pratiques exemplaires pour les processus de triage dans les cliniques de la douleur de niveau tertiaire. L'utilisation d'un modèle de référence structuré pourrait être un élément central de ces lignes directrices.

Cannabis in medicine: a national educational needs assessment among Canadian physicians.

BACKGROUND: There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. METHODS: A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. RESULTS: Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned "potential risks of using CTP" and "safety, warning signs and precautions for patients using CTP". The largest gap between perceived current and desired knowledge levels was "dosing" and "the development of treatment plans". CONCLUSIONS: We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps.