As a way of delineating different levels of cancer pain severity, we explored the relationship between numerical ratings of pain severity and ratings of pain's interference with such functions as activity, mood, and sleep. Interference measures were used as critical variable to grade pain severity. We explored the possibility that pain severity could be classified into groupings roughly comparable to mild, moderate, and severe. Our hypothesis was that mild, moderate, and severe pain would differentially impair cancer patients' function. We were able to identify boundaries among these categories of pain severity in terms of their interference with function. We also examined the extent to which cancer patients from different language and cultural groups differ in their self-reported interference as a function of pain severity level. We found optimal cutpoints that form 3 distinct levels of pain severity that can be defined on a 0-10-point numerical scale. We determined that, based on the degree of interference with cancer patients' function, ratings of 1-4 correspond to mild pain, 5-6 to moderate pain, and 7-10 to severe pain. Our analysis illustrates that the pain severity-interference relationship is non-linear. These cutpoints were the same for each of the national samples in our analysis, although there were slight differences in the specific interference items affected by pain. These cutpoints might be useful in clinical evaluation, epidemiology, and clinical trials.

OBJECTIVE: Assess impact of a computer‐based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN: Randomized controlled trial conducted between 1995 and 1998. SETTING: Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients. PARTICIPANTS: Newly diagnosed breast cancer patients (N = 246) under age 60. INTERVENTIONS: Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home‐based computer system providing information, decision‐making, and emotional support. MEASUREMENTS AND MAIN RESULTS: Pretest and two post‐test surveys (at two‐ and five‐month follow‐up) measured aspects of participation in care, social/information support, and quality of life. At two‐month follow‐up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five‐month follow‐up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS: Computer‐based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations.

Patients' beliefs can act as barriers to optimal management of cancer pain. The Barriers Questionnaire (BQ) is a tool used to evaluate such barriers. Here, the BQ has been revised to reflect changes in pain management practices, resulting in the Barriers Questionnaire-II (BQ-II), a 27-item, self report instrument. This paper presents the results from two studies where the psychometric properties of the BQ-II were evaluated. In the first study, the responses of 27 nurses trained in pain management were compared to responses of a convenience sample of 12 patients with cancer. The results indicated that patients with cancer had higher mean scores on the BQ-II than did nurses trained in pain management. In the second study, a convenience sample of 172 patients with cancer responded to the BQ-II and a set of pain and quality of life (QOL) measures. A factor analysis supported four factors. Factor one, physiological effects, consists of 12 items addressing the beliefs that side effects of analgesics are inevitable and unmanageable, concerns about tolerance, and concerns about not being able to monitor changes in one's body when taking strong pain medications. Factor two, Fatalism, consists of three items addressing fatalistic beliefs about cancer pain and its management. Factor three, Communication, consists of six items addressing the concern that reports of pain distract the physician from treating the underlying disease, and the belief that 'good' patients do not complain of pain. The fourth and final factor, harmful effects, consists of six items addressing fear of becoming addicted to pain medication and the belief that pain medications harm the immune system. The BQ-II total had an internal consistency of 0.89, and alpha for the subscales ranged from 0.75 to 0.85. Mean (SD) scores on the total scale was 1.52 (0.73). BQ-II scores were related to measures of pain intensity and duration, mood, and QOL. Patients who used adequate analgesics for their levels of pain had lower scores on the BQ-II than did patients who used inadequate analgesics. The BQ-II is a reliable and valid measure of patient-related barriers to cancer pain management.

" This article reexamines a number of methodological and procedural issues raised by Meehl (1967, 1978) that seem to question the rationality of psychological inquiry. The first issue concerns the asymmetry in theory testing between psychology and physics and the resulting paradox that, because the psychological null hypothesis is always false, increases in precision in psychology always lead to weaker tests of a theory, whereas the converse is true in physics. The second issue, related to the first, regards the slow progress observed in psychological research and the seeming unwillingness of social scientists to take seriously the Popperian requirements for intellectual honesty. We propose a good-enough principle to resolve Meehl's methodological paradox and appeal to a more powerful reconstruction of science developed by Lakatos (1978a, 1978b) to account for the actual practice of psychological researchers. From time to time every research discipline must reevaluate its method for generating and certifying knowledge. The actual practice of working scientists in a discipline must continually be subjected to severe criticism and be held accountable to standards of intellectual honesty, standards that are themselves revised in light of critical appraisal (Lakatos, 1978a). If, on a metatheoretical level, scientific methodology cannot be defended on rational grounds, then meta-theory must be reconstructed so as to make science rationally justifiable. The history of science is replete with numerous such reconstructions, from the portrayal of science as being inductive and justification-ist, to the more recent reconstructions favored by (naive and sophisticated) methodological falsifica-tionists, such as Popper (1959), Lakatos (1978a), and Zahar (1973). In the last two decades psychology, too, has been subjected to criticism for its research methodology. Of increasing concern is empirical psychology's use of inferential hypothesis-testing techniques and the way in which the information derived from these procedures is used to help us make decisions about the theories under test (e.g., Bakan, 1966; Lykken, 1968; Rozeboom, 1960). In two penetrating essays, Meehl (1967, 1978) has cogently and effectively faulted the use of the traditional null-hypothesis significance test in psychological research. According to Meehl (1978, p. 817), "the almost universal reliance on merely refuting the null hypothesis as the standard method for corroborating substantive theories [in psychology] is a terrible mistake, is basically unsound, poor scientific strategy, and one of the worst things that ever happened in the history of psychology." He maintained that it leads to a methodological paradox when compared to theory testing in physics. In addition, Meehl (1978) pointed to the apparently slow progress in psychological research and the deleterious effect that null-hypothesis testing has had on the detection of progress in the accumulation of psychological knowledge. The cumulative effect of this criticism is to do nothing less than cal...

Recent developments in procedures for conducting pairwise multiple comparisons of means prompted an empirical investigation of several competing techniques. Monte Carlo results revealed that the newer multistage sequential procedures maintain their familywise Type I error probabilities while exhibiting power that is superior to the traditional competitors. Of all procedures examined, the modified Peritz (1970) procedure (Seaman, Levin, Serlin, & Franke, 1990) is generally the most powerful according to all definitionsof power. At the same time, when computational ease and convenience are taken into consideration, Hayter's (1986) procedure should be regarded as a viable alternative. Beyond pairwise comparisons of means, the versatile Holm (1979) procedure and its modifications (Shaffer, 1986) are very attractive insofar as they represent simple, yet powerful, data-analytic tools for behavioral researchers.Researchers who are investigating differences among three or more experimental groups are often interested in the pairwise differences between group means. The choice of a multiplecomparison procedure (MCP) with which to assess these differ-

Although the consequences of ignoring a nested factor on decisions to reject the null hypothesis of no treatment effects have been discussed in the literature, typically researchers in applied psychology and education ignore treatment providers (often a nested factor) when comparing the efficacy of treatments. The incorrect analysis, however, not only invalidates tests of hypotheses, but it also overestimates the treatment effect. Formulas were derived and a Monte Carlo study was conducted to estimate the degree to which the F statistic and treatment effect size measures are inflated by ignoring the effects due to providers of treatments. These untoward effects are illustrated with examples from psychotherapeutic treatments.

The multiple-comparison procedure originally proposed by R. A. Fisher (1935) for the 1-way analysis of variance context has several desirable properties when K(ihe number of groups) is equal to 3. In this article, the logic of the procedure is described in conjunction with those properties. A discussion follows of how the Fisher procedure can be similarly applied in a number of other K = 3 (and, more generally, 2-degree-of-freedom) hypothesis-testing situations. Finally, the Fisher logic is combined with recent sequential applications of the Bonferroni inequality to illustrate the utility and versatility of that combination for the applied researcher.

We investigated the question of how cultural and linguistic backgrounds affect relationships among ratings (reported by patients with metastatic cancer) of pain's interference with such functions as activity, mood, and sleep. Multidimensional scaling (MDS) was used to analyze ratings of pain interference from a sample consisting of four culturally and linguistically different groups from the US (n = 1106), France (n = 324), the Philippines (n = 267), and China (n = 146). Patients all completed the Brief Pain Inventory, a self-report measure of pain and its interference with function. For each of these samples, MDS solutions consistently revealed two interpretable dimensions. In all samples, one dimension represented affect and the other dimension represented activity. The dimensions were consistently interpretable across all four samples and across three levels of pain severity ('mild', 'moderate', and 'severe'). The dimensions were most prominent when pain was moderate, rather than mild (when little interference was produced) or severe (when all domains were highly interfered with). These dimensions may have utility in the study of the epidemiology of pain and of the effectiveness of pain treatment. They may also be useful in clinical assessment to describe different patterns of pain interference.