Parents' Understanding of Information Regarding Their Child's Postoperative Pain Management

Abstract

Objectives-Unlike information provided for research, information disclosed to patients for treatment or procedures is largely unregulated and, as such, there is likely considerable variability in the type and amount of disclosure. This study was designed to examine the nature of information provided to parents regarding options for postoperative pain control and their understanding thereof.Methods-187 parents of children scheduled to undergo a surgical procedure requiring inpatient postoperative pain control completed questionnaires that elicited information regarding their perceptions and understanding of, and satisfaction with, information regarding postoperative pain management.Results-Results showed that there was considerable variability in the content and amount of information provided to parents based on the method of postoperative pain control provided. Parents whose child received Patient Controlled Analgesia (PCA) were given significantly (P< 0.025) more information on the risks and benefits compared to those receiving Nurse Controlled or intravenous-prn (NCA or IV) analgesia. Approximately one third of parents had no understanding of the risks associated with postoperative pain management. Parents who received pain information preoperatively and who were given information regarding the risks and benefits had improved understanding compared to parents who received no or minimal information (P< 0.001). Furthermore, information that was deemed unclear or insufficient resulted in decreased parental understanding.Discussion-These results demonstrate the variability in the type and amount of information provided to parents regarding their child's postoperative pain control and reinforce the importance of clear and full disclosure of pain information, particularly with respect to the risks and benefits.

Opioid Administration for Postoperative Pain in Children With Developmental Delay

“…This finding is consistent with other studies (Choi et al, 2008;Tait et al, 2008;Twycross & Collis, 2013;Twycross & Finley, 2013) that have included some assessment of parental satisfaction with their child's pain management. Indeed, as seen in other studies, parents indicated that they would want the pain medicine given the same way in the future , despite most parents reporting that their child experienced significant postoperative pain (Twycross & Collis, 2013;Twycross & Finley, 2013).…”

“…On the basis of previous investigations of parent satisfaction with opioid administration (Bozimowski, 2012;Tait et al, 2008;Weldon et al, 1993), we hypothesized that parents of children in the PNCA-with-basal group and their nurses would have greater overall satisfaction and potentially more positive comments than parents and nurses of children in the other two groups. In addition, we expected parents and nurses to be least satisfied with the IV PRN opioid regimen.…”

Parents’ Analgesic Trade-Off Dilemmas

“…Similar to previous data, 26 we found significant parental analgesic-related ADE knowledge deficits, even in parents who had received preoperative analgesic information and were preparing to make analgesic decisions following their child's surgery. We further demonstrated that Gist ADE Understanding was associated with a lower probability of giving opioids in the presence of nonserious as well as potentially serious ADEs.…”

“…Items were adapted, in part, from a previous study that assessed parents' understanding of their child's pain management. 26 Our assessment of knowledge and understanding was based on fuzzy trace theory which has been used to examine and explain health care decisions. 23,34 This theory posits that information is coded into memory with differing precision ranging from verbatim knowledge (ie, very specific numerical risk information) to "fuzzy" or "gist knowledge" (ie, crude or categorical representations such as presence/ absence of an attribute or lower/higher risk).…”

“…1,2,[25][26][27] Uncertainty may increase when parents are faced with complex, trade-off decisions that require weighing and balancing different treatment options. We recently demonstrated that although parents varied their decisions in response to differing levels of pain and ADEs presented in hypothetical scenarios, many did not respond appropriately to important ADE signals, continuing to give opioids to a child exhibiting potentially serious signs of oversedation.…”