Development and validation of the "cancer pain assessment difficulties in older patients with cognitive decline"...

This study aimed to develop and validate the Cancer Pain Assessment Difficulties in Older Patients with Cognitive Decline (CPAD-CD) scale, designed to assess the challenges nurses face in managing cancer pain for older patients with cognitive decline.

A three-phase process was used for scale development: (1) item generation through literature review and expert input, (2) content validation via expert review and a pilot study, and (3) psychometric evaluation, including exploratory factor analysis, confirmatory factor analysis, and reliability testing. The scale was administered to 199 nurses working in oncology and palliative care settings in Japan. Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was determined using intraclass correlation coefficients (ICCs). Known-groups validity was tested based on nurses' confidence levels and years of cancer nursing experience.

The final CPAD-CD scale comprised 32 items across five factors, and the internal consistency coefficients were ≥ 0.80, indicating strong internal consistency. Factor loadings ranged from 0.430 to 0.859. The test-retest reliability ICC was 0.797, demonstrating moderate reliability. Known-groups validity analyses showed significant differences in total scale and factor scores based on nurses' confidence and experience levels (P ​< ​0.05).

The CPAD-CD scale is a valid and reliable instrument for assessing difficulties in cancer pain management among nurses caring for older patients with cognitive decline. It can serve as a valuable tool for evaluating training needs and guiding interventions to enhance nursing competency in pain management. Further validation in diverse cultural and clinical contexts is recommended.