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Pain management at home in children with cancer: a daily diary study
Michelle A Fortier1, Aditi Wahi, Colette Bruce
1Department of Anesthesiology & Perioperative Care, University of California-Irvine, Orange, California; Department of Pediatric Psychology, CHOC Children's Hospital, Orange, California.
Insights
Parents struggle with managing children's cancer pain at home, leading to under-treatment. Addressing parental misconceptions about pain medication is crucial for improving pediatric cancer pain management.
Area of Science:
- Pediatric Oncology
- Pain Management
- Child Health
Background:
- Cancer pain management transitions from hospital to home care.
- Parents are primary caregivers for pediatric pain management at home.
- Limited empirical data exists on children's cancer pain in the home setting.
Purpose of the Study:
- Examine barriers to home-based cancer pain management by parents.
- Investigate pain and analgesic administration in children with cancer at home.
- Utilize a daily diary protocol to gather data on pediatric cancer pain.
Main Methods:
- Recruited 45 parent-child dyads from a children's hospital.
- Collected baseline data on demographics, quality of life, and parental beliefs.
- Parents completed 14-day daily diaries on pain and analgesic use.
Main Results:
- Most children experienced chronic cancer pain, but home analgesic administration was low.
- Parental misconceptions about analgesics correlated with lower medication administration.
- Child characteristics (shyness, social interaction, quality of life) influenced analgesic receipt.
Conclusions:
- A significant number of children experience chronic pain during outpatient cancer treatment.
- Children's cancer pain is often suboptimally managed in the home environment.
- Addressing barriers is vital to reduce pain in this vulnerable population.
Background:
With the transition of care of cancer patients from the hospital to the home setting, parents are largely responsible for children's pain management. Children's cancer pain is undermanaged, yet, there is little empirical data on the occurrence and management of cancer pain in the home setting. The purpose of the present study, therefore, was to employ a daily diary protocol to examine barriers to pain management of children's cancer pain by parents at home.
Procedure:
Parent-child dyads were recruited from the Cancer Institute at a major children's hospital in Southern California. A total of 45 patient/parent pairs completed baseline data on demographic and personality characteristics, children's quality of life, and parental beliefs regarding analgesic use for children and then completed daily diaries of pain and analgesic administration for 14 consecutive days.
Results:
Most children were reported to experience chronic pain while undergoing treatment for cancer, yet overall analgesic administration at home was low. Parents who reported misconceptions regarding analgesic use for children were less likely to administer pain medication to children. Children who were less shy, more social, or had lower quality of life were more likely to receive analgesics.
Conclusions:
A significant proportion of children receiving outpatient treatment for cancer were rated as experiencing chronic pain and pain was not optimally managed in the home setting. Further understanding and addressing barriers to children's cancer pain management in the home setting will aid in alleviating unnecessary pain in this vulnerable patient population.
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