The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family.

Children's pain is undertreated worldwide. Using a model of pediatric cancer pain management in Amman, Jordan, the authors demonstrated that an action research approach to pain service development resulted in a sustainable program of pain control. Barriers to care were due more often to health professionals' misconceptions concerning pain and opioid use than to concerns related to cultural, religious, or societal beliefs. Successful implementation of a pain management program requires education, policy development, and support from several levels of hospital administration. Role-modeling and mentorship are important factors. Established knowledge translation theories explained some but not all of the findings. Outcomes included consistent pain assessment and documentation by nursing staff, increased consultation for pain management, and increased use of intravenous opioids.

There has been little research on implementation of pediatric pain programs. These studies are part of a project to develop such a program for the King Hussein Cancer Centre in Jordan. Study 1 captured information on pain prevalence in 35 children using chart reviews and parent/child interviews to establish baseline pain burden. Forty-seven percent of children had pain at the time of interview; 11% had "a lot" of pain and only 22% received analgesics. Twenty-two parents were interviewed in Study 2 to identify attitudes toward pain management. Thematic analysis revealed six themes: 1) pain can and should be managed; 2) God's will; 3) parent's worst pain was emotional pain due to child's diagnosis; 4) belief that their presence could ameliorate their child's pain; 5) desire for shared decision making; and 6) the child's responsibility to express pain. These study results were used to inform the action research approach in the overall project.

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