Exploring the Implementation and Impacts of the Adult Comfort Promise: A Study Protocol

Pain is a barrier to completing in-office gynecological procedures. Best practice recommendations include pharmacotherapy, assessment techniques (trauma-informed history), environmental (distraction techniques, music), and other nonpharmacological interventions (heat, breathing). Yet, despite these best practices, the gap between evidence and practice persists. The implementation of pain management interventions for gynecological procedures requires further study. This study explores the implementation and impacts of a multicomponent intervention, the Adult Comfort Promise, to improve pain management for women and gender diverse adults.

We will complete an explanatory mixed-methods study to explore the implementation and impacts of the Adult Comfort Promise for two procedures: intrauterine device insertion and endometrial biopsy. In this three-phase study, we will first complete the quantitative phase, which includes intervention mapping, chart reviews, and surveys with patients and providers. In the second phase, we will explain the quantitative findings using semi-structured interviews with patients and providers. In the third phase, we will complete data integration and co-design implementation strategies for the intervention. We will analyze the quantitative data using descriptive statistics, including frequencies, mean, median, and mode. We will use an ANOVA to compare the effects of intervention components (distraction techniques to pharmacotherapy) on procedures (intrauterine device and endometrial biopsy) and their impact on pain management. The interview transcripts will be transcribed verbatim and analyzed using directed content analysis. We will include sex and gender in our analysis. The implementation strategy will be co-designed during workshops with providers and patients.

This research supports nurses and other healthcare professionals in their efforts to provide best practice pain management. These findings can serve as a resource for nurses as they continue to lead efforts in bridging knowledge-to-action gaps and implementing pain management interventions into practice.

This protocol presents an implementation science, explanatory mixed-methods study that explores the implementation and impacts of a pain management intervention at a Canadian tertiary women and children's hospital. This study has been approved by the IWK Research Ethics Board (#1031375). These findings will contribute to the evidence base of pain management interventions for women's health. They will also inform future implementation strategies for pain management at tertiary care centers for women, children, and gender-diverse adults. They may also be transferable to other procedures (hysteroscopes) or settings, such as primary care.