1. results Introduction As pain is both subjective and multidimensional, its assessment is challenging especially in children with cancer. The Adolescent Pediatric Pain Tool is a measure with 3 components: a word graphic rating scale (WGRS) for pain intensity, a body outline diagram (BOD) for pain location and a list of pain descriptors for pain quality, organized in 4 dimensions: sensory, affective, evaluative and temporal. SOLID FACTS I.Pain experience in cancer children is complex. II.Pain intensity scales are insufficient. III.Pain is often sub diagnosed and undertreated. IV.Inclusion of APPT in clinical practice has been defended. Aims of the study To culturally validate the APPT to European Portuguese and to examine the psychometrics properties of the translated version. Methodology Methodological study conducted in two phases. Phase 1 included the translation and back translation of the tool and its validation by a panel of experts and the author of the original version. The semantic and cultural validation of the list of descriptors was performed through Q-sort method with two samples of 24 Portuguese children, stratified by age (8-12yo; 13-17yo) and sex. Children were given 67 cards with printed descriptors and were asked to sort them in three groups: words that I know and use to describe pain, words that I know but don't use to describe pain and words that I don’t know. To be included on the final list of pain descriptors, a criterion was set of at least 75% of the children knowing the word. Unknown words were replaced and submitted to the second sample of children. Demographic data and percentage of words known, not known and used to describe pain were calculated. Phase 2 examined the psychometric properties of the APPT. One hundred Portuguese cancer children stratified by age (8-12yo; 13-17yo) and sex were included. The majority of the children (46%) had acute linbfoblastic leukemia and 54% had other forms of cancer. Seventy-five per cent of the children had a liquid neoplasm and 25% had a solid neoplasm. More than a half (55%) were in treatment and 45% were out of treatment. Children were asked to report their present pain or their last pain episode. Demographic data, number of pain sites and surface area, pain intensity and quality scores (total, sensory, evaluative, affective and temporal) were obtained. Psychometric properties were established by calculating the correlation between location, intensity and quality scores (Spearman test) and by testing the differences between groups of age and sex (Mann-Whitney U test). Construct validity of the theoretically organized dimensions was assessed using multiple correspondence analysis (MCA). Discussion I.Children revealed ability to discriminate pain descriptors that they know and use to describe from those that they know but wouldn’t use. II.Few descriptors were categorized as words that children don’t know which mirrors the relevance of these pain descriptors to Portuguese cancer children aged 8-17 yo. III.The 7 pain descriptors categorized as unknown are indeed words mostly used by Portuguese adults to characterize pain. IV.The diversity of words chosen to describe pain may be related to age, sex and past pain experiences. V.Words that are not frequently used to describe pain should not be removed from the list of descriptors, since they are meaningful to a group of children. VI.The results from the psychometric study support the validity and reliability of the Portuguese version of the APPT. VII. The structure of the APPT is appropriate for cancer children without the need for subgroup analysis in terms of age and sex. VIII. MCA shows a 4 dimension model not consistent with the theoretical model proposed (Wilkie et al, 1990). IX.MCA organizes dimensions according to patients responses (associative meaning) and not regarding its semantic meaning (theory) (Gracely, 1992). X.APPT appears to provide a rapid way of measuring pain on its three components: location, intensity and quality. Implications I.APPT can be used in clinical practice in order to better understand pain experiences and tailor pain control strategies. II.APPT can offer researchers a tool that assesses three components of the pain experiences: location, intensity and quality. III.APPT may offer the opportunity to better understand the relation between intensity, location/area and quality of pain. Future research I.It should be examined if a short form of the APPT is appropriate and if it reduces its burden. II.A clear relationship should be established between pain location, intensity and quality. References | GRACELY, R. H. (1992) – Evaluation of multi-dimensional pain scales. Pain. Vol. 48, p. 297-300.; SAVEDRA, M. [et al.](1989). Pain Location: Validity and Reliability of Body Outline Markings by Hospitalized Children and Adolescents. Research in Nursing & Health.Vol. 12, pp. 307-314.; SAVEDRA, M. [et al.] (1995). A Strategy to Assess The Temporal Dimension of Pain in Children and Adolescents. Nursing Research. Vol. 44, n. 5, p. 272-276.; TESLER, M. [et al.] (1991) - The Word- Graphic Rating Scale as a Measure of Children's and Adolescents' Pain Intensity. Research in Nursing & Health.Vol. 14, p. 361-371.; WILKIE, D.[et al.] (1990). Measuring pain quality: validity and reliability of children's and adolescents' pain language. Pain.Vol. 41, p. 151-159. PTDC/CS-SOC/113519/2009 Authors | FERNANDES, Ananda 1 ; BATALHA, Luís 1 ; CAMPOS, Catarina 1 ; OLIVEIRA, Armando 2 ; PERDIGÃO, Ana 1 1 Nursing School of Coimbra; 2 Faculty of Psychology and Education Sciences, University of Coimbra. PORTUGAL PHASE 1: Validation of the tool PHASE 2: Psychometric properties F ACE VALIDITY I.All the raters jugded the APPT as appropriate to assess pain in cancer children aged 8-17 yo. II.The instructions and WGRS anchors were considered well formulated and not ambiguous. C ONTENT VALIDITY I.All descriptors were chosen at least by 1 child. II.Only 1 child gave an additional descriptor. III.Few children did not selected none descriptors from each dimension. C ONVERGENT VALIDITY M ULTIPLE CORRESPONDENCE ANALYSIS Sensory Affective Evaluative Temporal Total=24 Sensory Affective Evaluative Temporal Total=16 Sensory Affective Evaluative Temporal Total=13 Sensory Affective Temporal Total=12 D1D2D3D4 Cronbach’s Alpha = 0.78 % of variance = 33,6% α = 0,86α = 0,77α = 0,72α = 0,68 This observed internal structure is not absolutely consistent with the model theoretically proposed. I.The translation and back translation procedure assured that all the descriptors maintained their semantic meaning while being culturally adjusted. II.In the first Q-sort, 7 pain descriptors were unknown to the children. These descriptors were replaced by other words and were resubmitted to the validation process. III. The 7 pain descriptors and two that were in the limb plus a children’s suggestion were submitted to a new Q-sort. IV.In the second Q-sort children knew all the new suggestions and these pain descriptors were retained in the final list. V.The Portuguese list of pain descriptors included 67 pain descriptors semantic and culturally validated to Portuguese cancer children aged 8-17 yo. *Correlation is significant at the 0.05 level (1-tailed). A multidimesional tool to assess pain in Portuguese children with cancer APPT Figure 1. Portuguese version of the APPT.