Mixed methods family-centered study of acute post-surgical pain experience in non-hispanic white and black children

IF 4 2区 医学 Q1 CLINICAL NEUROLOGY
Julia Kumar MD , Dylan Atkinson DO , Adaora Chima MBBS, MPH , Laura McLaughlin MA, CRC III , Rajvi Parikh MHA, CCRC III , Jiwon Lee MS. , Lili Ding PhD , Jennifer Allen , Peter Mende-Siedlecki PhD , Monica Mitchell PhD., MBA , Vidya Chidambaran MD, MS, MMM
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Abstract

Racial and neighborhood disparities in pediatric pain management are well-documented. This mixed-methods study engaged 19 Non-Hispanic Black (NHB) and 19 White (NHW) children with recent acute pain, along with their caregivers, to gain comprehensive insight into sociocultural factors and healthcare interactions impacting acute pediatric pain experiences. All children had acute post-surgical pain managed in tertiary care settings. Four focus groups per cohort (NHB and NHW) explored satisfaction with pain management, factors shaping pain experiences, and sociocultural beliefs surrounding pain and analgesia. Quantitative assessments included child measures of psychosocial factors, adverse childhood experiences (ACEs), pain coping, and resilience, alongside caregiver measures of socioeconomic status, pain catastrophizing, ACEs, racial and ethnic microaggressions (REMS), and responses to their child’s pain. Qualitative data were analyzed using thematic coding (NVivo©) and integrated with quantitative analyses. Several key shared themes emerged: empathetic care, shared decision-making, and healthcare provider responsiveness enhanced satisfaction/trust in pain care, while insurance-related delays detracted from satisfaction. Among NHB dyads, additional negative influences included lack of pain validation, racial discrimination, and socioeconomic constraints. Both cohorts expressed opioid hesitancy, stoicism, and use of distraction-based pain coping strategies. These themes aligned with quantitative findings of higher deprivation index (p=.005), elevated REMS subscale scores—Assumptions of Inferiority (p=.01) and Similarity (p=.02), and greater ACEs (p=.02) in NHB vs. NHW caregivers. Personal adverse experiences potentially shaped higher protective responses to their child’s pain (p=.005) in NHB (vs. NHW) caregivers. Our study sheds light on system-level factors that need to be addressed for an equitable pediatric pain experience.

Perspective

This mixed-methods study in NHB and NHW children with recent pain experiences and their caregivers highlights socioeconomic factors, racial bias, trust and healthcare provider interactions are important factors determining acute post-surgical pain experiences. Satisfaction with pain management, stoicism, distraction-based pain coping and hesitancy towards opioids were identified in both cohorts.
以家庭为中心的混合方法研究非西班牙裔白人和黑人儿童术后急性疼痛经历。
儿童疼痛管理的种族和社区差异是有据可查的。这项混合方法研究涉及19名非西班牙裔黑人(NHB)和19名白人(NHW)最近出现急性疼痛的儿童,以及他们的护理人员,以全面了解影响急性儿科疼痛体验的社会文化因素和医疗保健互动。所有患儿术后急性疼痛均在三级医疗机构处理。每个队列(NHB和NHW)四个焦点小组探讨了对疼痛管理的满意度,形成疼痛经历的因素,以及围绕疼痛和镇痛的社会文化信仰。定量评估包括儿童的心理社会因素、不良童年经历(ace)、疼痛应对和恢复力,以及照顾者的社会经济地位、疼痛灾难、ace、种族和民族微侵犯(REMS)和对孩子疼痛的反应。采用专题编码(NVivo©)对定性数据进行分析,并结合定量分析。出现了几个关键的共同主题:移情护理、共同决策和医疗保健提供者的响应增强了对疼痛护理的满意度/信任,而与保险相关的延迟则降低了满意度。在NHB双组中,其他负面影响包括缺乏疼痛验证、种族歧视和社会经济约束。两个队列都表现出阿片类药物犹豫、坚忍和使用基于分心的疼痛应对策略。这些主题与定量研究结果相一致:高剥夺指数(p= 0.005),高REMS亚量表得分-自卑假设(p= 0.01)和相似性(p= 0.02),高ace (p= 0.02)在NHB和NHW照顾者中。在NHB(相对于NHW)照顾者中,个人不良经历可能形成对孩子疼痛的更高保护反应(p= 0.005)。我们的研究揭示了系统层面的因素,需要解决一个公平的儿科疼痛经验。观点:这项对新近有疼痛经历的NHB和NHW儿童及其护理人员的混合方法研究强调了社会经济因素、种族偏见、信任和医疗保健提供者的互动是决定急性术后疼痛经历的重要因素。在两个队列中都发现了对疼痛管理的满意度,坚忍,基于分心的疼痛应对和对阿片类药物的犹豫。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Pain
Journal of Pain 医学-临床神经学
CiteScore
6.30
自引率
7.50%
发文量
441
审稿时长
42 days
期刊介绍: The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.
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