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Tofthagen, C., & McMillan, S. C. (2010).

Pain, neuropathic symptoms, and physical and mental well-being in persons with cancer.

Cancer Nursing, 33

(6), 436-444. doi:10.1097/NCC.0b013e3181e212b4

Using the above link, repond to the 5 prompts below. Each prompt less than 200 words.

Were the data collection methods/procedures appropriate to the research question(s) being studied? Were there the rationales given for the methods being used in the study? (Monica)

Yes, the methods of data collection were appropriate for the research question seeking to explore the experiences of cancer patients who describe their pain as neuropathic (numbness, tingling, or electric-like) vs not (Tofthagen & McMillan, 2010). From the parent study, it provided three questionnaires with four different instruments to measure pain experience, one at the beginning and two after intervention. This study only included data from the first set of questionnaires, allowing a comparison of the control and intervention groups pre intervention to get a baseline assessment of the patient’s experience of cancer pain. The rationales for the methods were given and described as combining the two groups questionnaires first, and then splitting them into the two subtypes of pain being explored in the research question to make comparisons.

Report the appropriateness of the instruments related to the study purpose. What levels of the measurement were achieved for measuring the study variables? [for example: ordinal level for the CESD etc.] (Marilyn)

The purpose of the study was to explore how cancer patients experienced pain if it included neuropathic pain (numbness, tingling, or electric-like sensations) compared to those whose pain did not include neuropathic pain (Tofthagen & McMillan, 2010). The instruments used to measure pain variables were the Memorial Symptom Assessment Scale (MSAS), the Medical Outcomes Study Short-Form (MOSS-F), and a revised version of the Brief Pain Inventory (BPI-R). Looking at depression from pain, the study also incorporated the Center for Epidemiologic Studies Sacel – Depression (CES-D). The validity and reliability of the MSAS was reported as strong in cancer patients and so that instrument was appropriate for the study’s purpose (Tofthagen & McMillan, 2010; Lobiondo-Wood & Haber, 2022, p. 339). Likewise, the BPI-R, which measured pain severity and interference with ADLs, was strongly reliable in previous studies and so this instrument was appropriate for this study measuring pain. The health-related quality of life (physical and emotional) instrument MOSS-F and the depression scale CES-D were also appropriate to the study of pain and effects on daily living and were found to be widely used and reliable in other studies. The levels of measurement achieved were:



Range (0-60 Scale)



Range (1-10 scale)



Range and Coefficients




Tofthagen & McMillan, 2010; LoBiondo-Wood, 2022, p. 283.

What were IVs and DV(s) in the study? Were all variables in the study adequately measured? (Brock)

The IVs are individuals with and without neuropathic pain descriptors (numbness, tingling, and electric-like sensations).

The DVs were pain, pain interference, MSAS symptom differences, health related quality of life and depression symptoms.

The DVs were adequately measured, some the instruments included Brief Pain Inventory revise (BPI-R) and Memorial Symptom Assessment Scale (MSAS)

Was there any evidence of potential bias for self-report instrument? If so, what was it? How did it affect the strength and quality of evidence? (Marla)

The study conducted had a bias based on ethnic group and religious background. Many of the patients included in this study were white with a religious background of Christianity. This could be due to the geographic location of the study which took place in southwest Florida. The study used a control group to compare the data collected. The mean age from both groups differed by 4 years. The use of four different assessment scales for patients to self-report their pain. The subject matter of this study is challenging since pain is subjective. This topic alone could lead to a bias in patients depending on their background. Based on self reporting of instruments that focused on “numbness, tingling, and electric like ” pain it could provide potential bias of not including other descriptions that could be neuropathic pain (Tofthagen & McMillan, 2010). Then without other descriptions related to use for neuropathic pain, there may have been an underestimation of the amount of patients with this type of pain possibly affecting the strength of the evidence.

Did the authors discuss reliability and/or validity of all instruments in the article? Choose two instruments and describe / evaluate the sufficiency of the reliability and validity information provided for the selected instrument. (Shawna)

The instruments used for this study included the Memorial Symptom Assessment Scale, Medical Outcomes Study Short-Form, and the Center for Epidemiologic Studies Scale-Depression and a revised version of the Brief Pain Inventory. (Tofthagen & McMillan, 2010) After discussing the instruments used, the authors described them as having a strong reliability or strong internal consistency for all instruments utilized in this study.

Cronbach’s alpha is used to test internal consistency. Alphas above 0.70 are sufficient evidence for supporting internal consistency. ( Lobiondo-Wood & Haber, 2018). Utilizing Cronbach’s alpha to evaluate reliability/validity, the authors identified in the MSAS a reliability of alpha =.83-.92 indicating low risk for bias. In the CES-D Cronbach alphas were .85 for the general public and .85-.91 in persons with cancer, indicating strong reliability. (Tofthagen & McMillan, 2010)


Lobiondo-Wood, G., & Haber, J. (2022).

Nursing research: Methods and critical appraisal for evidence-based practice

. Elsevier.

Tofthagen, C. S., & McMillan, S. C. (2010). Pain, neuropathic symptoms, and physical and mental well-being in persons with cancer. Cancer nursing, 33(6), 436–444.


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