DOI: 10.3886/icpsr39513
title: Measuring the Context of Healing: Using Patient-Reported Outcomes Measurement Information System in Chronic Pain Treatment [Methods Study], United States, 2014-2018
title: Archival Version

description: Patients' beliefs and expectations may affect how they respond to treatment. But these feelings are hard to measure.


In this study, the research team created a set of surveys called Healing Encounters and Attitudes Lists, or HEAL. HEAL helps researchers understand patients' beliefs and expectations about treatment. HEAL measures patients'


Connections with their doctors and nurses


Feelings about their doctor's office and staff


Expectations about treatment


Outlook on life


Strength of spiritual beliefs


Comfort with complementary and alternative medicine, or CAM


The team also used the Patient-Reported Outcomes Measurement Information System, or PROMIS, to measure patients' pain, health, and function. PROMIS is a set of surveys researchers and doctors use for many diseases and treatments.




The team wanted to learn if HEAL could predict how patients respond to treatment for chronic pain. Chronic pain is pain that lasts for months or years. The team used HEAL and PROMIS to look at why some groups of patients respond differently to treatment for chronic pain. Patients got either conventional treatment, such as physical therapy or medicine, or CAM, such as acupuncture, chiropractic treatment, or massage.
description: (1)To assess whether factors assessed by Healing Encounters and Attitudes Lists (HEAL) predict pain treatment outcomes in patients receiving complementary and alternative medicine (CAM) treatment or conventional medicine treatment; (2) To assess heterogeneity of treatment effects using the Patient-Reported Outcomes Measurement Information System (PROMIS) and HEAL
description: To measure how patient beliefs or treatment expectations may affect health outcomes, researchers developed HEAL, a set of item banks that measure patient-provider connection; healthcare environment perceptions; treatment expectancy, or patient expectations about whether the treatment will be helpful; positive outlook; spirituality; and attitudes toward CAM. Researchers also used PROMIS, a set of item banks measuring patient function, symptoms, behaviors, and feelings standardized to be comparable across various populations.
The study included 209 patients with chronic pain who completed HEAL and PROMIS measures online at baseline, or within one month of starting treatment, and then again two and four months later. The average age was 48, and 75% of patients were female. Of the patients, 76% were white, 23% were non-white and multiracial, and 7% were Hispanic.
For objective 1, at two and four months, researchers examined the relationship between baseline HEAL scores and patient-reported clinical global improvement and between baseline HEAL scores and PROMIS pain intensity and pain interference scores.
For objective 2, researchers assessed heterogeneity of treatment effects first based on type of treatment chosen by the patients (CAM versus conventional treatments) and second based on the patients' baseline HEAL treatment expectancy scores (higher versus lower treatment expectations). The team modeled separately the five pain and health outcomes using treatment type and HEAL treatment expectancy score as predictors, with and without controlling for baseline status for each pain treatment outcome, and examined longitudinal differences.
A group of patients, patient advocates, and clinicians gave input on research questions, study design, and dissemination of results.
description: Datasets: 
DS1: Measuring the Context of Healing: Using Patient-Reported Outcomes Measurement Information System in Chronic Pain Treatment [Methods Study], United States, 2014-2018
description: Patients with chronic pain lasting at least 3 months who started a CAM treatment within the past month with at least monthly visits.