Objective: While history of abuse has been tied to future aberrant opioid-related behavior, identifying at-risk patients is challenging. One way to circumvent the time required of clinicians to administer screening tools to assess at-risk patients is to have them complete Opioid Assessment Screening Tools (OASTs) independently. Unfortunately, 33% of American adults lack the literacy skills needed to comprehend patient education materials, including self-administered surveys. The aims of this study were to evaluate the cognitive complexity and reading demands of patient self-administered OASTs for adults with non-malignant pain.

Methods: We identified 6 English-language OASTs with established validity and reliability for inclusion in our study. A complete copy of each OAST (Current Opioid Misuse Measure [COMM], Medications Beliefs Questionnaire [MBQ], Pain Medication Questionnaire [PMQ], Screener and Opioid Assessment for Patient with Pain [SOAPP], Screening Instrument for Identifying Potential Opioid Abusers [SISAP], and Screening Tool for Addiction Risk [STAR]) was obtained from the original publication. Cognitive complexity of individual OAST statements/questions were assessed using 3 established techniques (number of items, number of words, and linguistic problems), while reading grade level was measured using the Flesch-Kinkaid formula.

Results: Number of total OAST statements/questions ranged from 5 (MBQ and SISAP) to 26 (PMQ), while number of words per statement/question averaged from 8.6±4.2 (SISAP) to 15.9±3.8 (PMQ). The SISAP (1.2±1.1) had the fewest, while the MBQ (3.6±1.1) had the most linguistic problems per statement/question. Although the reading level of OASTs ranged from approximately 4th (SISAP) to 8th (MBQ, COMM, PMQ) grade, there was notable variation in reading grade level across individual statements/questions.

Conclusions: The two most important findings of our study were that (1) linguistic problems were relatively common and (2) there was notable variation in reading grade level across OAST statements/questions. As a result, patients may not adequately comprehend OAST statements/questions above their reading ability.