Background Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. Methods Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. Results Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. Conclusion The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.

Objectives: Parents can play an integral role in managing their child’s pain, yet many parents remain unaware of evidence-based strategies to support their child during painful experiences. Recent advances in knowledge translation research, which include dissemination and implementation studies, have resulted in programs geared towards parents to offset this knowledge gap. The nature of these programs and the degree to which parents find them useful remains unclear. Our goal was to systematically review programs aimed as disseminating and implementing evidence-based pain-related knowledge to parents. Materials and Methods: Systematic searches of PubMed, Web of Science, CINAHL, and PsycInfo were completed. Articles in which information was disseminated to parents with the goal of assessing dissemination and implementation outcomes were retained. Information was extracted to identify study characteristics, primary outcomes, and quality of evidence. Results: A total of 24,291 abstracts were screened and 12 articles describing programs were retained. Programs were positively rated by parents in terms of the appropriateness of formats selected, presentation of information, and helpfulness of content. The majority of research has been focused in the area of procedural pain among infants. Although several implementation domains are reported by researchers, certain areas have been overlooked to date, including the cost and sustainability of programs. The majority of reports presented with methodological limitations and bias. Discussion: Knowledge translation research in pediatric pain is in its infancy. Development of theories and guidelines to increase the utility and quality of evidence are needed.

Background and Objectives Sustainable implementation of patient-oriented technologies in healthcare settings is challenging. Pre-implementation studies guided by the Consolidated Framework for Implementation Research (CFIR) can provide opportunities to address barriers and leverage facilitators that can maximize the likelihood of successful implementation. When looking to implement patient-oriented technologies, pre-implementation studies may also benefit from guidance from a conceptual framework specific to technology adoption such as the Unified Theory of Acceptance and Use of Technology (UTAUT). This study was, therefore, aimed at identifying determinants for the successful implementation of a patient-oriented technology (i.e., automated pain behavior monitoring [APBM] system) within a healthcare setting (i.e., long-term care [LTC] facility). Research Design and Methods Using a mixed-methods study design, 164 LTC nurses completed a set of questionnaires and 68 LTC staff participated in individual interviews involving their perceptions of an APBM system in LTC environments. Quantitative data were analyzed using a series of mediation analyses and narrative responses were examined using directed content analysis. Results Performance expectancy and effort expectancy partially and fully mediated the influence of implementation, readiness for organizational change, and technology readiness constructs on behavioral intentions to use the APBM system in LTC environments. Findings from the qualitative portion of this study provide guidance for the development of an intervention that is grounded in the CFIR. Discussion and Implications Based on our results, we offer recommendations for the implementation of patient-oriented technologies in healthcare settings.

Nonverbal pain cues such as facial expressions, are useful in the systematic assessment of pain in people with dementia who have severe limitations in their ability to communicate. Nonetheless, the extent to which observers rely on specific pain-related facial responses (e.g., eye movements, frowning) when judging pain remains unclear. Observers viewed three types of videos of patients expressing pain (younger patients, older patients without dementia, older patients with dementia) while wearing an eye tracker device that recorded their viewing behaviors. They provided pain ratings for each patient in the videos. These observers assigned higher pain ratings to older adults compared to younger adults and the highest pain ratings to patients with dementia. Pain ratings assigned to younger adults showed greater correspondence to objectively coded facial reactions compared to older adults. The correspondence of observer ratings was not affected by the cognitive status of target patients as there were no differences between the ratings assigned to older adults with and without dementia. Observers’ percentage of total dwell time (amount of time that an observer glances or fixates within a defined visual area of interest) across specific facial areas did not predict the correspondence of observers’ pain ratings to objective coding of facial responses. Our results demonstrate that patient characteristics such as age and cognitive status impact the pain decoding process by observers when viewing facial expressions of pain in others.