The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices.
child
health personnel
hematopoietic stem cell transplantation
pain
pain management
pediatrics
qualitative research
Journal
Pediatric blood & cancer
ISSN: 1545-5017
Titre abrégé: Pediatr Blood Cancer
Pays: United States
ID NLM: 101186624
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
29
06
2023
received:
02
02
2023
accepted:
26
07
2023
medline:
26
9
2023
pubmed:
7
8
2023
entrez:
7
8
2023
Statut:
ppublish
Résumé
Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment. To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices. A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14). The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain. There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
Sections du résumé
BACKGROUND
Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment.
OBJECTIVES
To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices.
METHODS
A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14).
RESULTS
The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain.
CONCLUSIONS
There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e30614Informations de copyright
© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.
Références
Kazak AE, Swain AM, Pai ALH, et al. Caregiver perspectives on psychosocial care in pediatric hematopoietic stem cell transplantation (HSCT). Clin Pract Pediatr Psychol. 2019;8(1):67-78. doi:10.1037/cpp0000278
Australasian Bone Marrow Transplant Recipient Registry: Annual Data Summary 2020. Australasian Bone Marrow Transplant Recipient Registry; 2020.
Pallera A, Schwartzberg L. Managing the toxicity of hematopoietic stem cell transplant. Support Oncol. 2004;2(3):223-247.
Yesilipek M, Karasu G. Hematopoetic stem cell transplantation in children. J Pediatr Sci. 2010;2(3):e30.
Plummer K, McCarthy M, McKenzie I, Newall F, Manias E. Experiences of Pain in Hospitalized Children During Hematopoietic Stem Cell Transplantation Therapy. Qualitative Health Research. 2021;31(12):2247-2259. doi: 10.1177/10497323211034161
Eccleston C, Fisher E, Cooper TE, et al. Pharmacological interventions for chronic pain in children: an overview of systematic revisews. Pain. 2019;160(8):1698-1707. doi:10.1097/j.pain.0000000000001609
Meghani SH, Vapiwala N. Bridging the critical divide in pain management guidelines from the CDC, NCCN, and ASCO for cancer survivors. JAMA Oncol. 2018;4(10):1323-1324. doi:10.1001/jamaoncol.2018.1574
Collins JJ, Geake J, Grier HE, et al. Patient-controlled analgesia for mucositis pain in children: a three-period crossover study comparing morphine and hydromorphone. J Pediatr. 1996;129(5):722-728. doi:10.1016/s0022-3476(96)70156-7
Pederson C, Parran L. Pain and distress in adults and children undergoing peripheral blood stem cell or bone marrow transplant. Oncol Nurs Forum. 1999;26(3):575-582.
Vasquenza K, Ruble K, Chen A, et al. Pain management for children during bone marrow and stem cell transplantation. Pain Manag Nurs. 2014;16(3):156-162. doi:10.1016/j.pmn.2014.05.005
Fuller C, Huang H, Thienprayoon R. Managing pain and discomfort in children with cancer. Curr Oncol Rep. 2022;24(8):961-973. doi:10.1007/s11912-022-01277-1
Pederson C, Parran L. Pain and distress in adults and children undergoing peripheral blood stem cell or bone marrow transplant. Oncol Nurs Forum. 1999;26(3):575-582.
Fisher D, Grap MJ, Younger JB, Ameringer S, Elswick RK. Opioid withdrawal signs and symptoms in children: frequency and determinants. Heart Lung. 2013;42(6):407-413. doi:10.1016/j.hrtlng.2013.07.008
White MC, Hommers C, Parry S, Stoddart PA. Pain management in 100 episodes of severe mucositis in children. Pediatr Anesth. 2011;21(4):411-416. doi:10.1111/j.1460-9592.2010.03515.x
Courade M, Bertrand A, Guerrini-Rousseau L, et al. Low-dose ketamine adjuvant treatment for refractory pain in children, adolescents and young adults with cancer: a pilot study. BMJ Support Palliat Care. 2022;12(e5):e656-e663. doi:10.1136/bmjspcare-2018-001739
Bredlau AL, Thakur R, Korones DN, Dworkin RH. Ketamine for pain in adults and children with cancer: a systematic review and synthesis of the literature. Pain Med. 2013;14(10):1505-1517. doi:10.1111/pme.12182
Ndao DH, Ladas EJ, Cheng B, et al. Inhalation aromatherapy in children and adolescents undergoing stem cell infusion: results of a placebo-controlled double-blind trial. Psychooncology. 2012;21(3):247-254. doi:10.1002/pon.1898
Sahler OJZ, Hunter BC, Liesveld JL. The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: a pilot feasibility study. Altern Ther Health Med. 2003;9(6):70-74.
Sencer SF, Zhou T, Freedman LS, et al. Traumeel S in preventing and treating mucositis in young patients undergoing SCT: a report of the Children's Oncology Group. Bone Marrow Transplant. 2012;47(11):1409-1414.
Craig KD. Social communication model of pain. Pain. 2015;156(7):1198-1199. doi:10.1097/j.pain.0000000000000185
Al Mulla N, Kahn JM, Jin Z, et al. Survival impact of early post-transplant toxicities in pediatric and adolescent patients undergoing allogeneic hematopoietic cell transplantation for malignant and nonmalignant diseases: recognizing risks and optimizing outcomes. Biol Blood Marrow Transplant. 2016;22(8):1525-1530. doi:10.1016/j.bbmt.2016.05.012
Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Method. 2011;11:100. doi:10.1186/1471-2288-11-100
Yin RK. Case Study Research: Design And Methods. 5th ed. Sage Publications Inc; 2014.
Abma TA, Stake RE. Science of the particular: an advocacy of naturalistic case study in health research. Qual Health Res. 2014;24(8):1150-1161. doi:10.1177/1049732314543196
Creswell JW. Research Design: Qualitative, Quantitative and Mixed Methods Approaches. 4th ed. Sage Publications; 2014.
Craig KD. The social communication model of pain. Can Psychol. 2009;50(1):22-32. doi:10.1037/a0014772
Etikan I, Musa SA, Alkassim R. Comparison of convenience sampling and purposive sampling. Am J Theor Appl Stat. 2016;5(1):1-4. doi:10.11648/j.ajtas.20160501.11
Campbell S, Greenwood M, Prior S, et al. Purposive sampling: complex or simple? Research case examples. J Res Nurs. 2020;25(8):652-661. doi:10.1177/1744987120927206
Schug SA, Palmer GM, Scott DA, Halliwell R, Trinca J. Acute pain management: scientific evidence, fourth edition, 2015. Med J Aust. 2016;204(8):315-317. doi:10.5694/mja16.00133
Nvivo qualitative data analysis software. Version 10. QSR International; 2012.
Ritchie R, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, eds. Analyzing Qualitative Data. Routledge; 1994:173-194.
Saldana J. The Coding Manual for Qualitative Researcher. SAGE Publications Ltd; 2013.
Affaitati G, Costantini R, Tana C, Cipollone F, Giamberardino MA. Co-occurrence of pain syndromes. J Neural Transm. 2020;127(4):625-646. doi:10.1007/s00702-019-02107-8
Anghelescu DL, Faughnan LG, Hankins GM, et al. Methadone use in children and young adults at a cancer center: a retrospective study. J Opioid Manag. 2012;7(5):353-361.
Dahmani S, Michelet D, Abback PS, et al. Ketamine for perioperative pain management in children: a meta-analysis of published studies. Paediatr Anaesth. 2011;21(6):636-652. doi:10.1111/j.1460-9592.2011.03566.x
Royal Children's Hospital clinical practice guidelines. Acute pain management. Royal Children's Hospital; Updated 2020. Accessed June 22, 2023. https://www.rch.org.au/clinicalguide/guideline_index/Analgesia_and_sedation/
World Health Organization. Persisting pain in children package: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. World Health Organization; 2012.
Eisdorfer S, Galinkin J. Opioid use disorder in children and adolescents. Clin J Pain. 2019;35(6):521-524. doi:10.1097/AJP.0000000000000708
Ehrentraut JH, Kern KD, Long SA, An AQ, Faughnan LG, Anghelescu DL. Opioid misuse behaviors in adolescents and young adults in a hematology/oncology setting. J Pediatr Psychol. 2014;39(10):1149-1160. doi:10.1093/jpepsy/jsu072
Jibb LA, Ameringer S, Macpherson CF, Sivaratnam S. The symptom experience in pediatric cancer: current conceptualizations and future directions. Curr Oncol Rep. 2022;24(4):443-450. doi:10.1007/s11912-022-01222-2
Loeffen EAH, Kremer LCM, van de Wetering MD, et al. Reducing pain in children with cancer: methodology for the development of a clinical practice guideline. Pediatr Blood Cancer. 2019;66(6):e27698. doi:10.1002/pbc.27698
Loeffen EAH, Mulder RL, Kremer LCM, et al. Development of clinical practice guidelines for supportive care in childhood cancer-prioritization of topics using a delphi approach. Support Care Cancer. 2015;23(7):1987-1995. doi:10.1007/s00520-014-2559-7
Dowden S, McCarthy M, Chalkiadis G. Achieving organizational change in pediatric pain management. Pain Res Manag. 2008;13(4):321-326.
Stevens B, Riahi S, Cardoso R, et al. The influence of context on pain practices in the NICU: perceptions of health care professionals. Qual Health Res. 2011;21(6):757-770. doi:10.1177/1049732311400628
Palermo TM, Law EF, Fales J, Bromberg MH, Jessen-Fiddick T, Tai G. Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial. Pain. 2016;157(1):174-185. doi:10.1097/j.pain.0000000000000348
Palermo TM, Murray C, Aalfs H, et al. Web-based cognitive-behavioral intervention for pain in pediatric acute recurrent and chronic pancreatitis: protocol of a multicenter randomized controlled trial from the study of chronic pancreatitis, diabetes and pancreatic cancer. Contemp Clin Trials. 2020;88:105898. doi:10.1016/j.cct.2019.105898
Birnie KA, Campbell F, Nguyen C, et al. iCanCope PostOp: user-centered design of a smartphone-based app for self-management of postoperative pain in children and adolescents. J Med Internet Res. 2019;3(2):e12028. doi:10.2196/1202849
Fortier MA, Chung WW, Martinez A, Gago-Masague S, Sender L. Pain buddy: a novel use of m-health in the management of children's cancer pain. Comput Biol Med. 2016;76:202-214. doi:10.1016/j.compbiomed.2016.07.012
Hunter JF, Kain ZN, Fortier MA. Pain relief in the palm of your hand: harnessing mobile health to manage pediatric pain. Pediatr Anesth. 2019;29(2):120-124. doi:10.1111/pan.13547
Chan E, Hovenden M, Ramage E, et al. Virtual reality for pediatric needle procedural pain: two randomized clinical trials. J Pediatr. 2019;209:160-167.e4. doi:10.1016/j.jpeds.2019.02.034
Atzori B, Hoffman HG, Vagnoli L, et al. Virtual reality analgesia during venipuncture in pediatric patients with onco-hematological diseases. Front Psychol. 2018;9:2508.
Birnie KA, Kulandaivelu Y, Jibb L, et al. Usability testing of an interactive virtual reality distraction intervention to reduce procedural pain in children and adolescents with cancer. J Pediatr Oncol Nurs. 2018;35(6):406-416.
Jibb LA, Nathan PC, Stevens BJ, et al. Psychological and physical interventions for the management of cancer-related pain in pediatric and young adult patients: an integrative review. Oncol Nurs Forum. 2015;42(6):E339-E357. doi:10.1188/15.onf.e339-e357
Salvador Á, Crespo C, Roberto MS, Barros L. Do parents of children with cancer want to participate in treatment decision-making? Support Care Cancer. 2020;28:1059-1067. doi:10.1007/s00520-019-04909-8
Allingham C, Gillam L, McCarthy M, et al. Fertility preservation in children and adolescents with cancer: pilot of a decision aid for parents of children and adolescents with cancer. JMIR Pediatr Parent. 2018;1:e10463. doi:10.2196/10463
Robertson EG, Wakefield CE, Cohn RJ, et al. Piloting a parent and patient decision aid to support clinical trial decision making in childhood cancer. Psychooncology. 2019;28(7):1520-1529. doi:10.1002/pon.5109
Robertson EG, Wakefield CE, Shaw J, et al. Decision-making in childhood cancer: parents’ and adolescents’ views and perceptions. Support Care Cancer. 2019;27(11):4331-4340. doi:10.1007/s00520-019-04728-x
Kaye EC, Friebert S, Baker JN. Early integration of palliative care for children with high-risk cancer and their families. Pediatr Blood Cancer. 2016;63(4):593-597. doi:10.1002/pbc.25848
Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative care in pediatric oncology and hematopoietic stem cell transplantation. Curr Oncol Rep. 2022;24(2):161-174. doi:10.1007/s11912-021-01174-z
Mekelenkamp H, Schröder T, Trigoso E, et al. Specialized pediatric palliative care services in pediatric hematopoietic stem cell transplant centers. Children. 2021;8(8):615. doi:10.3390/children8080615
Collins GS, Beaman H, Ho AM, Hermiston ML, Cohen HJ, Dzeng EW. Perceptions of specialty palliative care and its role in pediatric stem cell transplant: a multidisciplinary qualitative study. Pediatr Blood Cancer. 2021;69(1):e29424. doi:10.1002/pbc.29424