Psychometric evaluation of the Chinese version of the Breakthrough Pain Assessment Tool (BAT-C) in cancer patients

The aim of this study was to adapt the original English Breakthrough Pain Assessment Tool (BAT) into a Chinese version (BAT-C), following Beaton's cross-cultural adaptation guidelines, and evaluate its psychometric properties among cancer patients, thereby providing a foundation for the standardized and evidence-based assessment of breakthrough pain in this population.

This study employed a cross-sectional design for psychometric validation. The English BAT underwent cultural adaptation according to Beaton' s cross-cultural adaptation framework to develop the BAT-C. A convenience sampling strategy was utilized to recruit 310 cancer patients with breakthrough pain from four tertiary hospitals in Hebei Province, with data collected to examine the psychometric properties (reliability and validity) of the BAT-C.

Pre-test analysis revealed no significant ceiling or floor effects. The BAT-C comprises nine items organized into two dimensions-Severity and Impact of Breakthrough Pain, Onset Characteristics and Medication Effectiveness-alongside five open-ended items. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, while the scale-level content validity index (S-CVI/Ave) reached 0.976. Exploratory factor analysis extracted two common factors explaining 82.521% of the cumulative variance. Confirmatory factor analysis confirmed acceptable model fit, with indices as follows: χ²/df = 1.733, RMSEA = 0.061, CFI = 0.988, TLI = 0.983, IFI = 0.988, and GFI = 0.953. Convergent validity was confirmed by composite reliability (CR) values of 0.927 and 0.900, and average variance extracted (AVE) values of 0.724 and 0.648. The scale demonstrated a Cronbach' s α of 0.869 (95% CI: 0.85-0.89, SE: 0.012), with dimension-specific coefficients of 0.937 and 0.861. McDonald' s ω was 0.947, with a hierarchical ω of 0.675; the Spearman-Brown coefficient was 0.828. Known-groups validity analysis indicated that, after controlling for confounding variables, the BAT-C significantly differentiated patients across ECOG performance statuses (P < 0.05, partial η² = 0.021).

The BAT-C exhibited robust psychometric properties in this sample, providing preliminary support for its clinical utility as an assessment instrument for breakthrough pain in Chinese cancer patients; however, further validation is warranted in larger and more diverse populations.