Why a Global PROMIS® Can't Be Kept

Composite multi-dimensional constructs, such as ‘global mental health’ and ‘global physical health’, in PROMIS® instruments and ICHOM standard outcome sets, are formative, not reflective. Their preference-insensitivity means they are potentially misleading in both clinical and policy decision making practice. Their frequent validation by reflective psychometric tests is also improper methodologically. The spread of these instruments is occurring without sufficient awareness on the part of patients, clinicians, researchers and policy makers that the need for group-specific preference bases (‘tariffs’) for such measures rules out any possibility of ‘international gold standard metrics’

The Experiences Of Black American Older Adults Managing Pain: A Nursing Ethnography

Introduction: Pain can negatively affect quality of life for Black elders. They are less likely to report pain concerns and have voiced pain needs adequately met. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility. Methods: 106 participants completed a questionnaire comprised of a demographic tool, the PROMIS Global Health Scale (PROMIS), the Brief Pain Inventory (BPI), and the Psychological Stress Measure (PSM-9). Additionally, participant observation, informal interviews, and 20 formal recorded interviews with individuals identified as having pain were completed. Qualitative and frequency analysis and were finished using NVIVO 10 qualitative data analysis software, and IBM SPSS Statistics 22. Results indicate that 86 percent of the sample had an average pain rating of 7 on a 0 to 10 scale with 5 pain sites. Pain interference, was about 4, on a 0 to 10 scale. Specific areas of interference areas included general activity (5.59), walking (5.73) and normal work (5.7). Participants preferred nonpharmacological treatments for pain such as exercise and Epsom salt soaks along with non-opioid analgesics that came in cream/liquid form. Preferences were related to concerns with side effects, fears of addiction, and provider mistrust. Prescription medications most commonly used for pain included hydrocodone with acetaminophen, acetaminophen with codeine, tramadol, and Ibuprophen. 17 percent of the population took no pain medications. Global physical health scores for patients with pain were 36, while Global mental health scores were about 44. Respectively 2 and 0.5 standard deviations lower than the US norms. Mild to moderate stress was reported by the PSM-9. Adaptive coping strategies used by participants to manage pain included: remaining positive, exercise/ remaining active, being engaged in the community, prayer/meditation, and maintaining positive support systems. Poverty was an additional stressor to managing pain. Discussion: Pain management may be improved in Black elders by proving balanced health information—in written form—with both benefits and burdens of treatments, questioning and discussing medication concerns in-office, increasing patient follow-up post-office visit for pain related visits, and increasing provider familiarity with commonly used home remedies and treatments