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Response by McDonald and Molony

We thank our reviewer colleagues for their astute comments and their efforts to strengthen the body of nursing knowledge. We believe that post hoc changes made in study protocols may lead to inappropriate practice decisions when researchers are not forthright about the changes. We urge readers to take into account the changes that we have clearly described when evaluating the usefulness of our findings for practice. Our study was the second in a series of studies attempting to refine and test an intervention assisting older adults to communicate their pain management needs after surgery and obtain more effective pain relief. The initial study (McDonald, Freeland, Thomas, & Moore, 2001) supported a significant decrease in pain over time but included only one control group in which older adults were taught to use two pain intensity scales. The results did not clarify whether the pain communication skills or the pain management information alone significantly improved the pain outcomes for the older adults. To clarify whether the pain communication skills provided a distinct contribution to obtaining more effective pain relief, our study included a treatment group and two comparison groups—one receiving the pain management videotape intervention and one receiving no additional intervention. Pocock and White (1999) caution that when clinical trials are prematurely stopped, the findings tend to have an upward bias, unfairly supporting the hypothesis. Our study continued to include the comparison group receiving the pain management intervention, making it more difficult to demonstrate a significant difference from the treatment group. We decided to collect additional data, recruiting only for the treatment and the comparison groups with pain management education because the initial results indicated near significant results, suggesting that additional data might support a significant difference. We continued to randomly assign participants to the treatment group or comparison group. Additional participants supported rather than refuted our hypothesis. We have a moral obligation to complete the studies that we begin and to maintain scientific integrity throughout our studies. Participants often take part in studies because they believe the findings might be helpful for themselves or others. Failure to complete or disseminate findings (Krzyzanowska,