Evidence-Based Development and Initial Validation of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II)
Chan, Sarah Lok Chuen
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Pain is undertreated in long-term care (LTC) facilities, in part because of difficulties in evaluating pain among seniors with dementia and limited ability to communicate (Wynne, Ling, & Remsburg, 2000). One of the leading assessment tools for this population is the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC; Fuchs-Lacelle & T. Hadjistavropoulos, 2004). Although the PACSLAC has strong psychometric properties and is frequently preferred by LTC staff for its clinical utility (Lints-Martindale, T. Hadjistavropoulos, Lix & Thorpe, 2012; Zwakhalen, Hammers & Berger, 2006), it consists of 60 items that may be considered to be too many for use at some busy settings. Moreover, like most tools of its kind, it contains items that overlap with conditions that may be unrelated to pain (e.g., delirium). The goal of this study was to develop the PACSLAC-II, a shorter tool that would improve on the PACSLAC. Revisions to the PACSLAC resulted in the PACSLAC-II which is of shorter length, contains items that are more pain-specific and continues to cover all pain assessment domains that are deemed to be important by the American Geriatrics Society (AGS) Panel on Persistent Pain in Older Persons (2002). Psychometric properties and clinical utility of the 31-item PACSLAC-II were then examined through two studies. In the first study, the PACSLAC-II was used to assess pain based on video footage of LTC residents with dementia undergoing painful procedures as part of routine care. Its ability to discriminate pain from non-pain related states was compared to that of pre-existing tools using archival data. The PACSLAC-II demonstrated satisfactory reliability and excellent validity. As well, it discriminated across pain-related situations and baseline while accounting for more variance than six other tools that are commonly considered in the literature, including the original PACSLAC. Moreover, the PACSLAC-II accounted for unique variance with respect to ability to discriminate across pain-related situations and baseline, even after controlling for all other measures combined. A second study involved the use of the PACSLAC and PACSLAC-II in LTC facilities by front line nurses and care aides in order to solicit feedback from health care providers. Qualitative analysis of this feedback was conducted. Many LTC nurses and care aides preferred the PACSLAC-II due to its length and condensed nature, which may facilitate documentation and greater efficiency in pain assessment and management. However, a smaller number of nurses and care aides reported preference for the original PACSLAC. Despite the preference for the PACSLAC expressed by some staff members, the psychometric examination of the tools indicated that the shorter version had better discriminative properties. Feedback interview data also revealed that both tools were considered to be clinically useful by the LTC staff. Overall, the findings of this investigation indicate that the empirical and theoretically-driven revisions to the PACSLAC led to improved ability to differentiate between pain and non-pain states, while retaining its clinical utility for front line staff. Future studies of the PACSLAC-II may focus on examining its psychometric properties in LTC settings and its role in pain management decision-making.