PRISM: a screening measure of stress and behaviors for parents of children with chronic pain
Broman, Emily Catherine
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Having a child who is suffering with chronic pain can profoundly impact a parent’s life. Reciprocally, parent cognitive, emotional, and behavioral responses to their child’s chronic pain can influence the child pain experience. We developed the Parent Risk and Impact Screening Measure (PRISM) to assess parent physical and emotional functioning, behavioral responses to child pain, and impact on daily life due to their child’s chronic pain. In an effort to validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. The 30-item PRISM was administered via RedCAP survey to 112 parents of children with persistent pain presenting to a multidisciplinary pain clinic at Boston Children’s Hospital. Parents also completed the Patient Reported Outcomes Measurement Information System (PROMIS-29), Bath Adolescent Pain Questionnaire-Parental Impact Questionnaire (BAQ-PIQ), Adult Responses to Children’s Symptoms (ARCS), and Pain Catastrophizing Scale (PCS). Children completed the Functional Disability Inventory (FDI), Fear of Pain Questionnaire (FOPQ), and Pediatric Quality of Life Inventory (PedsQL). Parents were predominantly mothers (84%), married (74%), and college- educated (70%). Their children (ages 8-18) were predominantly female (88%) and endorsed daily pain (84%; Mean=6/10). PRISM total scores were strongly correlated with parent general symptoms of depression, anxiety, fatigue, social restrictions, and pain interference (PROMIS-29; r=0.47, 0.54, 0.59, 0.57, 0.38). PRISM total scores were also highly associated with parent pain-specific domains including self-blame and helplessness (BAP-PIQ; r=0.62), parent behavior (BAP-PIQ; r=0.54), and protective responses (ARCS; r=0.59). For child outcomes, higher PRISM scores correlated with more disability (FDI; r=0.49), higher fear of pain (FOPQ; r=0.53), and lower functioning within emotional, social, and psychosocial domains (PedsQL; r=0.36, 0.34, 0.48). Altogether the PRISM tool appears to be a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Future work will include item level analysis with the goal of reducing the length of this screening tool.