75 Factors that Influence Parental Decision-making Regarding Analgesia for their Children with Musculoskeletal Injury-related Pain: A Qualitative Study
Notice bibliographique
Résumé
Abstract Background Parents/caregivers are often the gatekeepers for the pharmacologic management of their children’s pain. Parents’ unique expertise in assessing their children’s pain reactions, alongside a deep emotional drive to protect their children, make them invaluable advocates and partners. Parents are highly invested in optimizing pain management outcomes for children. Concerns and preferences regarding medications, including opioids, influence their choices. An improved understanding of caregiver decision-making should encourage a family-centred approach to communication with parents when deciding analgesic plans for children with acute pain, facilitate shared clinical decision-making, and optimize paediatric pain management outcomes in the clinical setting. Objectives Our primary objective was to explore and understand caregiver decision-making as it relates to acute pain management for children presenting to the emergency department, with particular focus on opioids. Design/Methods This qualitative study was embedded within an ongoing paediatric clinical trial (‘The No OUCH Trials’, NCT03767933), which aims to evaluate the clinical efficacy of a combination of oral opioid (hydromorphone) and non-opioid (ibuprofen and acetaminophen) analgesics to manage paediatric musculoskeletal injury-related pain. This study employed one-on-one semi-structured interviews. Parents of children with acute musculoskeletal injuries were recruited from three Canadian paediatric emergency departments (Stollery Children’s Hospital [Edmonton, Alta.], CHU Sainte-Justine [Montreal, Qué.], and Winnipeg Children’s Hospital [Winnipeg, Man.]). Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. Results Twenty-seven interviews were completed. Five major themes regarding pain assessment and treatment emerged: a) My child’s comfort is a priority; b) Every situation is unique; c) Opioids only if necessary; d) Considerations when choosing opioids; and e) Pain research is important. Overall, parents were highly comfortable with their assessment of their child’s pain. Participants’ willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Although considerations for opioid use were similar between opioid-averse and opioid-willing families, the trade-offs between maximizing pain relief and minimizing risks were weighed differently. Conclusion Our study revealed that parents assess their child’s pain and distress as a global entity, with great confidence in their own assessment and decision-making. For most parents, the desire to relieve their children’s pain outweighed concerns of addiction, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centred approaches to co-decision-making of analgesic plans for children with acute pain.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,024 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,008 | 0,007 |
| Communication savante | 0,003 | 0,004 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».