{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:51:46Z","timestamp":1768830706016,"version":"3.49.0"},"reference-count":23,"publisher":"Walter de Gruyter GmbH","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_sjpain-2021-0002_s_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Breakthrough cancer pain (BTcP) is a transient exacerbation of pain that occurs over persistent, stable, and adequately controlled cancer background pain. It is prevalent and bears severe consequences to patients\u2019 quality-of-life. The effective management of BTcP depends on fast and reliable (re)assessment. The Breakthrough pain Assessment Tool (BAT) is one of the most concise and reliable self-report instruments adapted to clinical contexts so far, showing good\u00a0psychometric qualities in the United Kingdom, the Netherlands, and South Korea. As to promote the effective management of BTcP in Portuguese-speaking communities this study, first aimed to culturally adapt and validate the Portuguese version of the BAT (BAT-Pt). Second, and most importantly, it sought to provide novel evidence on its criterion validity by investigating its association with measures of psychological distress, which has not been yet investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2021-0002_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The BAT was translated into European Portuguese, using the back-translation method, and culturally adapted. Its psychometric properties (factor structure, internal consistency, construct and criterion validity) were analyzed in a cross-sectional multicenter study, with a sample of 65 cancer patients (49.2% women) recruited from eight hospitals in mainland Portugal (\n                      <jats:italic>a priori<\/jats:italic>\n                      power analysis determined a minimum sample of 50). Health professionals collected patients\u2019 clinical information, assessed their functional disability (\n                      <jats:italic>ECOG Performance Status<\/jats:italic>\n                      ) and the adequacy of pain control. In addition to the Portuguese version of the BAT (BAT_Pt), patients completed the Portuguese versions of the\n                      <jats:italic>Brief Pain Inventory<\/jats:italic>\n                      , the\n                      <jats:italic>Hospital Anxiety and Depression Scale<\/jats:italic>\n                      , a\n                      <jats:italic>Distress Thermometer<\/jats:italic>\n                      and answered questions about the adequacy of pain control.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2021-0002_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The BAT-Pt was very well accepted by experts and patients. As hypothesized, a Principal Axis Factor Analysis revealed two underlying factors accounting for 55.2% of the variance: (1)\n                      <jats:italic>Pain Severity and Impact<\/jats:italic>\n                      of BTcP and (2)\n                      <jats:italic>Duration of BTcP and Medication Inefficacy.<\/jats:italic>\n                      Two items (on episode frequency and medication efficacy) were analyzed separately given their lower\/cross loadings. The BAT-Pt showed good internal consistency overall (\n                      <jats:italic>\u03b1<\/jats:italic>\n                      =0.79) and for each sub-scale, namely,\n                      <jats:italic>Pain Severity and Impact<\/jats:italic>\n                      of BTcP (n=5 items;\n                      <jats:italic>\u03b1<\/jats:italic>\n                      =0.86) and\n                      <jats:italic>Duration of BTcP and Medication Inefficacy<\/jats:italic>\n                      (n\n                      <jats:italic>=<\/jats:italic>\n                      2 items; r\n                      <jats:sub>sb<\/jats:sub>\n                      =0.62). The BAT-Pt showed good convergent validity, being moderately to strongly associated with overall pain severity and interference (0.46&lt;r&lt;0.77, p&lt;0.001). It also showed good concurrent validity by being associated not only with physical outcomes\u00a0\u2013 such as functional disability (r=0.40, p&lt;0.001) and patient- and physician-determined adequacy of BTcP control (|0.25&lt;r\n                      <jats:sub>pb<\/jats:sub>\n                      &lt;0.63|, p\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      &lt;0.05)\u00a0\u2013 but also, with distress (0.33&lt;r&lt;0.46, p\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      &lt;0.001), anxiety (0.28&lt;r&lt;0.44, p\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      &lt;0.05) and depression (r=0.47, p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_sjpain-2021-0002_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BAT-Pt is a reliable and valid measure of breakthrough pain in Portuguese cancer patients and it is strongly associated to physical and psychological outcomes. This study confirms and extends the psychometric validation of the BAT to a new cultural context, promoting its diffusion and use by researchers and clinicians in Portuguese-speaking communities. The BAT-Pt may be an invaluable tool for daily clinical practice by tapping multiple aspects of BTcP experiences that are associated to patients\u2019 physical and psychological outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/sjpain-2021-0002","type":"journal-article","created":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T16:04:30Z","timestamp":1619798670000},"page":"688-695","source":"Crossref","is-referenced-by-count":5,"title":["Cultural adaptation and psychometric validation of the Portuguese breakthrough pain assessment tool with cancer patients"],"prefix":"10.1515","volume":"21","author":[{"given":"S\u00f3nia F.","family":"Bernardes","sequence":"first","affiliation":[{"name":"Iscte-Instituto Universit\u00e1rio de Lisboa (Iscte-IUL), Centro de Investiga\u00e7\u00e3o e Interven\u00e7\u00e3o Social (CIS-Iscte) , Lisbon , Portugal"}]},{"given":"Marta","family":"Matos","sequence":"additional","affiliation":[{"name":"Iscte-Instituto Universit\u00e1rio de Lisboa (Iscte-IUL), Centro de Investiga\u00e7\u00e3o e Interven\u00e7\u00e3o Social (CIS-Iscte) , Lisbon , Portugal"}]},{"given":"Susana","family":"Mour\u00e3o","sequence":"additional","affiliation":[{"name":"Iscte-Instituto Universit\u00e1rio de Lisboa (Iscte-IUL), Centro de Investiga\u00e7\u00e3o e Interven\u00e7\u00e3o Social (CIS-Iscte) , Lisbon , Portugal"}]},{"given":"Christin-Melanie","family":"Vauclair","sequence":"additional","affiliation":[{"name":"Iscte-Instituto Universit\u00e1rio de Lisboa (Iscte-IUL), Centro de Investiga\u00e7\u00e3o e Interven\u00e7\u00e3o Social (CIS-Iscte) , Lisbon , Portugal"}]}],"member":"374","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"key":"2025120910043539113_j_sjpain-2021-0002_ref_001","doi-asserted-by":"crossref","unstructured":"Van Den Beuken-Van, MH, Hochstenbach, LM, Joosten, EA, Tjan-Heijnen, VC, Janssen, DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag 2016;51:1070\u201390.","DOI":"10.1016\/j.jpainsymman.2015.12.340"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_002","doi-asserted-by":"crossref","unstructured":"Davies, AN, Dickman, A, Reid, C, Stevens, AM, Zeppetella, G. The management of cancer-related breakthrough pain: recommendations of a task group of the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland. Eur J Pain 2009;13:331\u20138. https:\/\/doi.org\/10.1016\/j.ejpain.2008.06.014.","DOI":"10.1016\/j.ejpain.2008.06.014"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_003","doi-asserted-by":"crossref","unstructured":"Portenoy, R, Hagen, N. Breakthrough pain: definition, prevalence and characteristics. Pain 1990;41:273\u201381. https:\/\/doi.org\/10.1016\/0304-3959(90)90004-w.","DOI":"10.1016\/0304-3959(90)90004-W"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_004","doi-asserted-by":"crossref","unstructured":"Zeppetella, G, O\u2019Doherty, CA, Collins, S. Prevalence and characteristics of breakthrough pain in cancer patients admitted to a hospice. J Pain Symptom Manag 2000;20:87\u201392. https:\/\/doi.org\/10.1016\/s0885-3924(00)00161-5.","DOI":"10.1016\/S0885-3924(00)00161-5"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_005","doi-asserted-by":"crossref","unstructured":"Deandrea, S, Corli, O, Consonni, D, Villani, W, Greco, MT, Apolone, G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manag 2014;47:57\u201376. https:\/\/doi.org\/10.1016\/j.jpainsymman.2013.02.015.","DOI":"10.1016\/j.jpainsymman.2013.02.015"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_006","doi-asserted-by":"crossref","unstructured":"Caraceni, A, Martini, C, Zecca, E, Portenoy, RK, Working Group of an IASP Task Force on Cancer Pain. Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey. Palliat Med 2004;18:177\u201383. https:\/\/doi.org\/10.1191\/0269216304pm890oa.","DOI":"10.1191\/0269216304pm890oa"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_007","doi-asserted-by":"crossref","unstructured":"Katz, NP, Gajria, KL, Shillington, AC, Stephenson, JJ, Harshaw, Q. Impact of breakthrough pain on community-dwelling cancer patients: results from the National Breakthrough Pain Study. Postgrad Med 2017;129:32\u20139. https:\/\/doi.org\/10.1080\/00325481.2017.1261606.","DOI":"10.1080\/00325481.2017.1261606"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_008","doi-asserted-by":"crossref","unstructured":"Liu, Q, Gao, LL, Dai, YL, Wang, Y, Wang, HX, Luo, XJ, et al.. Breakthrough pain: a qualitative study of patients with advanced cancer in Northwest China. Pain Manag Nurs 2018;19:506\u201315. https:\/\/doi.org\/10.1016\/j.pmn.2017.11.006.","DOI":"10.1016\/j.pmn.2017.11.006"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_009","doi-asserted-by":"crossref","unstructured":"Portenoy, RK, Payne, D, Jacobsen, P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 1999;81:129\u201334. https:\/\/doi.org\/10.1016\/s0304-3959(99)00006-8.","DOI":"10.1016\/S0304-3959(99)00006-8"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_010","doi-asserted-by":"crossref","unstructured":"Zeppetella, G. 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J Pain Symptom Manag 2017;54:361\u20137. https:\/\/doi.org\/10.1016\/j.jpainsymman.2017.07.011.","DOI":"10.1016\/j.jpainsymman.2017.07.011"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_013","doi-asserted-by":"crossref","unstructured":"Oldenmenger, WH, Lucas, A, van der Werff, GF, Webber, K, Visser, D, van der Velden, AWG, et al.. Validation of the Dutch version of the breakthrough pain assessment tool in patients with cancer. J Pain Symptom Manag 2020;59:709\u201316. https:\/\/doi.org\/10.1016\/j.jpainsymman.2019.12.009.","DOI":"10.1016\/j.jpainsymman.2019.12.009"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_014","unstructured":"DeVellis, RF. Scale development: theory and applications. Los Angeles: Sage Publications; 2016, vol 26."},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_015","unstructured":"Skinner, C, Thompson, E, Davies, A. Clinical features. In: Davies, A, editor. Cancer-related breakthrough pain. Oxford: Oxford University Press; 2006:13\u201322 pp."},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_016","doi-asserted-by":"crossref","unstructured":"Beaton, DE, Bombardier, C, Guillemin, F, Ferraz, MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000;24:3186\u201391. https:\/\/doi.org\/10.1097\/00007632-200012150-00014.","DOI":"10.1097\/00007632-200012150-00014"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_017","doi-asserted-by":"crossref","unstructured":"Andersen, RD, Jylli, L, Ambuel, B. Cultural adaptation of patient and observational outcome measures: a methodological example using the COMFORT behavioral rating scale. Int J Nurs Stud 2014;51:934\u201342. https:\/\/doi.org\/10.1016\/j.ijnurstu.2013.10.006.","DOI":"10.1016\/j.ijnurstu.2013.10.006"},{"key":"2025120910043539113_j_sjpain-2021-0002_ref_018","doi-asserted-by":"crossref","unstructured":"Beatty, PC, Willis, GB. 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