The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

Abstract

BackgroundBeliefs of caregivers about patient's pain have been shown to influence assessment and treatment of children's pain, now considered an essential part of cancer treatment. Painful procedures in hematology-oncology are frequently referred by children as the most painful experiences during illness. Aim of this study was to evaluate professionals' beliefs about painfulness of invasive procedures repeatedly performed in Pediatric Hemato-Oncology Units.MethodsPhysicians, nurses, psychologists and directors working in Hemato-Oncology Units of the Italian Association of Pediatric Hematology-Oncology (AIEOP) were involved in a wide-nation survey. The survey was based on an anonymous questionnaire investigating beliefs of operators about painfulness of invasive procedures (lumbar puncture, bone marrow aspirate and bone marrow biopsy) and level of pain management.ResultsTwenty-four directors, 120 physicians, 248 nurses and 22 psychologists responded to the questionnaire. The score assigned to the procedural pain on a 0-10 scale was higher than 5 in 77% of the operators for lumbar puncture, 97.5% for bone marrow aspiration, and 99.5% for bone marrow biopsy. The scores assigned by nurses differed statistically from those of the physicians and directors for the pain caused by lumbar puncture and bone marrow aspiration. Measures adopted for procedural pain control were generally considered good.ConclusionsInvasive diagnostic-therapeutic procedures performed in Italian Pediatric Hemato-Oncology Units are considered painful by all the caregivers involved. Pain management is generally considered good. Aprioristically opinions about pain depend on invasiveness of the procedure and on the professional role.

Pain management practices surrounding lumbar punctures in children: A survey of Canadian emergency physicians

“…Children view lumbar punctures (LPs) as painful 1 and distressing. 2 Compared to adults, 3 subcutaneous lidocaine is underutilized in children, 4 despite evidence 5-8 and guidelines supporting its use. [9][10][11] Numerous studies demonstrate a suboptimal provision of analgesia in neonates and children undergoing LPs.…”

Perceptions of parents and paediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukaemia: a qualitative study in China

“…42 Thus, it is essential that healthcare workers realise their responsibilities and obligations for children's pain management. In our study, all of the paediatricians reported that there was no clinical training on pain management and nine (82%) suggested that formal training would be useful.…”

General anesthesia, conscious sedation, or nothing: Decision‐making by children during painful procedures

“…Careful attention to the emotional outcomes of invasive procedures is often limited, and only 36% of Centers of Pediatric Oncology and Hematology in Italy reported that they ask children to give an assessment of the pain experienced following the procedure, and only 22% ask during the procedure …”

“…Careful attention to the emotional outcomes of invasive procedures is often limited, and only 36% of Centers of Pediatric Oncology and Hematology in Italy reported that they ask children to give an assessment of the pain experienced following the procedure, and only 22% ask during the procedure. 53 The eventual evaluation of pain control efficacy is assigned to either the operators themselves or the caregivers, 54,55 although the child's perception of the invasiveness of the procedure and the related painful experience has been confirmed to be poorly understood. [56][57][58][59][60][61] Therefore, we considered that involving children in decision-making about medical support during the procedure could mitigate some of their emotional distress.…”