Family Pain Questionnaire (FPQ)

Abstract

The Family Pain Questionnaire (FPQ) is a specialized 16-item ordinal scale designed to evaluate the knowledge and subjective experience of family caregivers regarding the management of chronic pain associated with cancer. Developed by Ferrell and colleagues in the early 1990s, the FPQ is intended for use in conjunction with the Patient Pain Questionnaire (PPQ) to facilitate a holistic understanding of pain perception and adjustment within the family unit. The instrument is divided into two main subscales: Knowledge (9 items) and Experience (7 items), and is suitable for both clinical and research settings focused on oncology and palliative care.

Keywords

Family Pain Questionnaire, FPQ, caregiver knowledge, cancer pain, pain management, psychometrics, Patient Pain Questionnaire, chronic illness.

Authors

Ferrell, B. R., Rhiner, M., Rivera, L. M.

Purpose

The primary purpose of the Family Pain Questionnaire (FPQ) is to quantify the understanding and emotional impact of the patient’s pain experience on the family member acting as the primary caregiver. By assessing both knowledge (e.g., beliefs about addiction, medication scheduling) and subjective experience (e.g., perceived pain intensity, distress), the FPQ highlights potential gaps in understanding or maladaptive coping strategies within the family system managing chronic malignant pain.

The FPQ is uniquely valuable when administered alongside the Patient Pain Questionnaire (PPQ). This dual assessment approach allows clinicians and researchers to analyze the congruence or divergence between the patient’s and caregiver’s perceptions of pain, which can be predictive of overall adjustment and effectiveness of pain management interventions. Results from the FPQ can directly inform the development and evaluation of targeted pain management education programs in oncology settings.

Construct

The FPQ measures two specific constructs related to the family’s engagement with chronic pain: Pain Knowledge and Pain Experience. The Knowledge subscale (9 items) focuses on the caregiver’s cognitive understanding of fundamental pain management principles, including medication efficacy, the risks of addiction, the benefits of around-the-clock dosing, and the role of non-pharmacological interventions. Misconceptions in this area can lead to inadequate pain relief for the patient.

The Experience subscale (7 items) captures the caregiver’s affective and observational responses. This includes their perception of the patient’s pain intensity, the level of pain relief achieved, and the degree of distress that the patient’s pain causes both the patient and the caregiver personally. It also assesses the caregiver’s perceived sense of control over the pain and their prognostic expectations for the patient’s future pain trajectory, providing insight into the emotional burden of caregiving.

Validity

The validity of the FPQ was established through rigorous psychometrics testing, as detailed in the seminal work by Ferrell, Rhiner, and Rivera (1993). Content validity was assessed by experts in the field and demonstrated a high Content Validity Index (CVI) of 0.90, indicating strong relevance and comprehensive coverage of the construct domain by the scale items.

Construct validity was supported using Analysis of Variance (ANOVA), yielding a statistically significant result (p < 0.05). Furthermore, concurrent validity, which measures the correlation between the FPQ results and a relevant external measure (likely the PPQ), was established with a correlation coefficient of r = 0.60 (p < 0.05), suggesting that the FPQ scores align well with contemporaneous measures of related variables concerning pain perception.

Reliability

The reliability of the Family Pain Questionnaire was confirmed through multiple statistical methods, ensuring the stability and consistency of the measurement. Test-retest reliability was examined in a sample of 67 caregivers (N=67). This analysis yielded a strong correlation coefficient of r = 0.80, demonstrating the stability of the instrument’s measurements over time.

In addition to test-retest measures, internal consistency reliability was also established during the psychometric analysis phase. High internal consistency indicates that the items within the FPQ are highly correlated with each other and accurately measure the intended constructs (Knowledge and Experience).

Factor Analysis

A series of factor analyses were performed on the FPQ during its development to confirm the underlying structure of the 16 items. This statistical procedure supported the intended theoretical structure of the tool, demonstrating that the items clustered into two distinct and meaningful components: the 9-item Knowledge subscale and the 7-item Experience subscale.

This structural validation is crucial as it ensures that the subscales provide meaningful, independent measures of the distinct cognitive and affective aspects of caregiver response to the patient’s chronic pain experience. The factor structure enables researchers to analyze data by focusing on either the subscales or the individual items, depending on the research or clinical objective.

Instrument

Test Type: Self-report ordinal scale inventory

Format: 16 items, typically administered via mail or in person. Responses are collected using a 0 to 10 numerical rating scale with descriptive anchors (e.g., Disagree/Agree or No Pain/A Great Deal).

Language Available: English, Spanish (Cuestionario Sobre el Dolor Para la Familia)

Population Group: Family Caregivers of patients suffering from chronic pain

Age Group: Adult caregivers

Population Details: Caregivers assisting patients, often family members, with chronic malignant pain due to cancer.

Test Methodology: Caregivers rate their agreement/disagreement or intensity/distress levels on the 0-10 scale. Scoring is standardized such that 0 represents the most positive outcome (e.g., “will get better” or “disagree” with a negative statement), and 10 represents the most negative outcome (e.g., “will get worse” or “agree” with a negative statement).

Keywords

Pain Knowledge, Pain Experience, palliative care, oncology, chronic illness, family support, assessment tool.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: Not provided in source.

Correspondence Address: Betty R. Ferrell PhD, FAAN Research Scientist (Specific mailing address not provided in source).

Permissions & Fee and Test Year

The developer, Betty R. Ferrell, explicitly granted permission for the duplication and use of this instrument in research and clinical practice. The FPQ was initially developed and evaluated in the early 1990s, with the primary psychometric reference published in 1993. No information regarding a required licensing fee or cost for use is provided in the source material.

Reference’s

1. Ferrell, B. R., Rhiner, M., & Rivera, L. M. (1993). Development and Evaluation of the Family Pain Questionnaire. Journal of Psychosocial Oncology, 10(4):21-35.
2. Ferrell, B. R, Ferrell, B., Rhiner, M., & Grant, M. (1991). Family Factors Influencing Cancer Pain. Post Graduate Medical Journal, 67 (Suppl 2), 64-69.
3. Ferrell, B. R., Rhiner, M., Shapiro, B., & Strause, L. (1994). The Family Experience of Cancer Pain Management in Children. Cancer Practice, 2(6), 441-446.
4. Ferrell BR, Rhiner M, Cohen M, & Grant M. (1991). Pain as a Metaphor for Illness. Part I: Impact of Cancer Pain on Family. Oncology Nursing Forum, 18(8):1303-1309.
5. Ferrell BR, Cohen M, Rhiner M, & Rozak. (1991). Pain as a Metaphor for Illness. Part II: Family Caregivers’ Management of Pain. Oncology Nursing Forum, 18(8):1315-1321.
6. Ferrell BR, Ferrell B, Chan J, & Ahn C. (1995). The Impact of Cancer Pain Education on Family Caregivers of Elderly. Oncology Nursing Forum, 22(8):1211-1218.
7. Ferrell BR, Grant M, Borneman T, Juarez G, & ter Veer. (1999). Family Caregiving in Cancer Pain Management. Journal of Palliative Medicine, 2(2):185-195.

Items of the Family Pain Questionnaire (FPQ)

Below are a number of statements about cancer pain and pain relief. Please circle a number on the line to indicate your response.

disagree      0          1       2         3         4         5         6       7       8       9        10     agree

Knowledge

1. Cancer pain can be effectively
2. Pain medicines should be given only when pain is

3. Most cancer patients on pain medicines will become addicted to the medicines over
4. It is important to give the lowest amount of medicine possible to save larger doses for later when the pain is
5. It is better to give pain medications around the clock (on a schedule) rather than only when
6. Treatments other than medications (such as massage, heat, relaxation) can be effective for relieving
7. Pain medicines can be dangerous and can often interfere with
8. Patients are often given too much pain
9. If pain is worse, the cancer must be getting

Experience

no pain        0          1       2         3         4         5         6       7       8       9        10     a great deal

10. Over the past week, how much pain do you feel your family member has had?

11. How much pain is your family member having now?

12. How much pain relief is your family member currently receiving?

13. How distressing do you think the pain is to your family member?

14. How distressing is your family members’ pain to you?

15. To what extent do you feel you are able to control the patient’s pain?

16. What do you expect will happen with your family member’s pain in the future?

Cuestionario Sobre el Dolor Para la Familia (siglas en ingles: F.P.Q.)

A continuacion se encuentran un numero de afirmaciones el dolor ocasionado por el cancer y su alivio. Favor de marcar uno de los numeros en el renglon con un circulo para indicar su respuesta.

Conocimiento

estoy de acuerdo         0          1       2         3         4         5         6       7       8       9        10     no estoy de acuerdo

1. El dolor del cancer puede aliviarse

2. Las medicinas para aliviar el dolor se deben de dar unicamente cuando el dolor sea

3. La mayoria de los pacientes con cancer que toman medicamentos para aliviar el dolor a la larga quedaran adictos a los

4. Es importante dar la menor cantidad posible de la medicina con fines de guardar las dosis mas altas para cuando empeore el dolor en un

5. Es preferible dar los medicamentos para alivar el dolor a base continua (segun un horario) en vez de solo cuando estos sean

6. Otros tratamientos ademas de los medicamentos (tales como masajes, tratamientos de calor, relajacion pueden ser eficaces para alivar el

7. Los medicamentos contra el dolor pueden ser peligrosos y con frecuencia pueden interferir con la

8. A los pacientes con frequencia les dan demasiados medicamentos para aliviar el

9. Si el dolor empeora, el cancer debera estar

10. Durante esta ultima semana, cuanto dolor ha tenido su pariente?

11. Cuanto dolor esta sufriendo/sintiendo su pariente en la actualidad?

12. Cuanto alivio al dolor esta recibiendo su pariente en la actualidad?

13. Cuanta afliccion/angustia piensa usted que le causa a su pariente el dolor que tiene?

14. Cuanta afliccion/angustia le causa a usted el dolor que tiene su pariente?

15. Hasta que punto estima usted que puede controlar el dolor de su pariente?

16. Que piensa usted pasara con el dolor de su pariente en un futuro?