**4.4 Alberta breakthrough pain assessment tool (ABPAT)**

ABPAT was developed by Alberta Cancer Board and the Alberta Cancer Foundation. It is an emerging tool for pain prognostics and works under the boundaries of assessing breakthrough pain. This method was developed by a knowledgeable panel of the reviewer by utilizing the Delphi process and conducting many patient's think-aloud interviews [34, 36]. Breakthrough pain is generally categorized as a sudden increase or flaring of existing chronic pain such as in cases of cancer or joint-related problems [33]. It is reported that breakthrough pain in cancer patients, its occurrence is about 40–93%, hence quite common as it has come up quite a lot of times that no standardized assessment tool exists so the goal of Alberta breakthrough pain assessment tool was to provide a standardized format for research purposes [34]. Using the opinion of experts in this field reaching a consensus a questionnaire of 17 questions was put out. Next came the validation of this process, whether the patients were understanding what they have been asked to fill up so that the researcher added the think-aloud to judge the comprehensive and cognitive understanding of the people participating in the survey (**Figure 4**). This helped in the revaluation of their question by rigorous feedback from the participants and adding any changes in between.

The format of questions participants was asked:


This was well evaluated in a study conducted that was mentioned by Sperlinga R. where approximately 90% of the participants said that the questions were understandable and 80% said that it is a good tool for the breakthrough problem [35]. The validation and reviewing of the results were done both nationally and internationally such as in UK, Australia, Middle-East, Israel and North America and many respondents that participated in the survey were from medical nursing fields [34].
