Manifestation and parental assessment of children's cancer pain at home: An exploratory mixed-methods study

Systematic Review of Pain Assessment Measures Used in Pediatric Acute Lymphoblastic Leukemia

BACKGROUND

Pain is a prevalent, frequent, and often persistent symptom among children with acute lymphoblastic leukemia (ALL). Despite its high prevalence, pain has remained understudied, and no evidence-based recommendations exist for how best to assess and treat pain in this population. Without proper assessment, clinical efforts to improve pain management in pediatric ALL will be ineffective.

AIMS

Therefore, the purpose of this systematic review is to describe and identify gaps in measurement approaches that have been used to assess pain in pediatric ALL, evaluate the psychometric properties of available pediatric pain measures, and provide recommendations for clinical research and practice.

METHODS

Literature searches were performed following Cochrane and PRISMA guidelines for systematic reviews. Domains of pain assessed, measures used to assess pain, measure format, respondent, and timing of pain assessment were extracted from studies that met inclusion criteria. The psychometric properties of included measures were then evaluated. A total of 238 full-text articles were screened and 123 met inclusion criteria.

RESULTS

Most studies assessed pain using generic health-related quality of life instruments rather than pain-specific measures. A total of 39 measures were used across the 123 included studies, and the psychometric properties of the measures varied considerably.

CONCLUSIONS

Recommendations include a selection of well-validated pain assessment measures that are currently available and can be used to facilitate best practices in ALL pain assessment. Clinicians and investigators are encouraged to utilize a multidimensional pain assessment approach to inform and enhance pain care in pediatric ALL.

A meta-synthesis of the language of pediatric pain

AIM

This study aims to conduct a meta-synthesis to explore the language of pain in children.

METHOD

We conducted a meta-synthesis, following the outline proposed by Sandelowski. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO, Web of Science, SAGE, and Wiley. The Primary keywords used were pediatric pain, pain expression, communication, and qualitative studies. We included articles in English within the field of pediatric nursing between 1989 and 2023. Initially, 563 records were identified which reduced to 508 references after removing duplicates. Subsequently, we assessed 172 full-text articles for eligibility and 10 relevant studies were ultimately included. Quality appraisal was conducted with no study being excluded. Data were synthesized using the qualitative thematic analysis method.

RESULTS

The analysis of the data yielded one main theme (the language of pain) and four subthemes. The subthemes were expressive discourse (phonetic expressions, verbal expression, and symbolic expression), subtle gestures of expression (behavioral discrepancies, self-harm, face grimaces, and eye changes), embodied communication (early neonatal to infant movements, older infants movements, and somatic movement), and silent endurance (endurance due to fear of invasive procedure, worrying family, and social isolation).

CONCLUSION

From phonetic utterances to nuanced gestures, this study underscores the intricate ways children convey their pain.

IMPLICATION

These findings underscore the importance of healthcare practitioners recognizing and interpreting diverse modes of children's pain expression for accurate assessment. Implementing a holistic approach that integrates verbal, nonverbal, and embodied communication can enhance pediatric pain management practices.

Exploring the role of pain on physical activity among youth with acute lymphoblastic leukemia using the biopsychosocial model

BACKGROUND

Engaging in physical activity (PA) throughout cancer treatment offers many benefits, but may be challenging due to cancer-related pain. Pain research in pediatric cancer has primarily focused on procedural pain, with fewer studies exploring how pain affects PA. The current study qualitatively investigated the impact of pain on PA in youth with acute lymphoblastic leukemia (ALL) using a biopsychosocial framework.

PROCEDURE

As part of a larger study, caregivers (N = 17) of a child diagnosed with ALL and on treatment for less than 1 year completed a semi-structured interview about perceptions of their child's health behaviors during ALL treatment. This secondary analysis focused specifically on discussions about pain and its impact on PA. We followed Braun and Clarke's (2006) six-step thematic analysis framework to identify themes of pain-related barriers to PA.

RESULTS

Key pain-related barriers endorsed by caregivers included: interactions among pain and treatment effects, caregiver distress around seeing their child in pain, and fear of interfering with medical equipment. Despite these barriers, caregivers found creative solutions to adapt activities for their child. Caregivers were reassured by PA advice from their medical team; however, advice varied between teams.

CONCLUSION

The relationship between pain and PA during ALL treatment is influenced by an intricate system of biological (e.g., treatment effects), psychological (e.g., parental distress), and social (e.g., communication among families and medical teams) factors. Future directions include identifying evidence-based PA recommendations and exploring family-team communication dynamics. This study also highlights a need to prioritize ALL pain management and involve caregivers in behavioral treatment protocols to improve PA.

Being the nurse for my child at home: A qualitative analysis of parental recognition, appraisal, and reactions to childhood cancer in Ghana

Parental involvement in childhood cancer care is of utmost importance, but the understanding of parental recognition, appraisal, and reactions to childhood cancer in settings such as Ghana is limited. We conducted an empirical phenomenological study to explore these aspects among Ghanaian parents. Twenty parents were purposively sampled to participate in semi-structured interviews between June and September 2022. All interviews were transcribed and analysed using an inductive thematic approach. We found that parents recognised symptoms through personal observation and their child's self-report, often perceiving them as non-severe. Emotional reactions upon receiving their child's cancer diagnosis included psychological distress, fear, doubts, and confusion. Enduring emotions experienced by parents were fears of disease recurrence and impending death of their child. Parents assumed the role of nurses at home, monitoring therapy effects, managing pain and symptoms, and dressing wounds. In conclusion, parents in Ghana play a crucial role in the recognition, diagnosis, and treatment pathways of childhood cancer. To enhance their ability to recognise symptoms and take timely actions, it is recommended to implement media programs and health education initiatives targeting parents.

Parental Experiences of Adolescent Cancer-Related Pain: A Qualitative Study

Objective

Despite advancing medical treatments, pain remains a significant outcome of adolescent cancer, as both a problematic and distressing symptom. With adolescents spending substantial periods of time at home during cancer treatment, parents perceive themselves as central to the experience and management of adolescents’ pain. The present study aimed to explore parental experiences of adolescent cancer-related pain during, and recently after, completing cancer treatment.

Methods

We interviewed 21 parents of adolescents (aged 12–18 years) with cancer, recruited through a hospital in South West England. Interviews were analyzed using reflexive inductive thematic analysis.

Results

Two themes were generated. The first theme, “Parental perceptions of being at the heart of pain management,” focused on the role of parents in adolescents’ pain journeys, and the vast knowledge they gained. The second, “Adapting and readjusting expectations,” captured parents’ journeys in learning to adjust their lives according to adolescents’ pain and difficulties they faced throughout this process.

Conclusions

Findings highlighted parents’ crucial role throughout adolescents’ pain experiences; learning how to manage adolescents’ pain, and supporting them with the detrimental impact on their lives. The findings emphasize the importance of a multidisciplinary approach to supporting families to manage pain. They also indicate a need for targeted research studies investigating parental experiences of adolescent cancer-related pain. This will help professionals understand how best to support parents and adolescents throughout the cancer journey and ultimately improve the physical and psychological outcomes of young people in the longer term.

Effectiveness of animal-assisted therapy on pain in children: A systematic review and meta-analysis

Aims

Animal-assisted therapy (AAT) relieves pain by creating a relaxed and comfortable environment to reduce anxiety in children. Yet little is known about its effects on pain in children. This study aims to systematically evaluate the effects of AAT on pain in children.

Methods

Eight databases including PubMed, Cochrane Library, Web of Science, CINAHL Complete, Chinese Biomedical Database (CBM), Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI) and Wanfang Database were retrieved, and all randomized controlled trials or controlled clinical trial using AAT on children’s pain were recruited from inception to October 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. RevMan 5.3 software was employed for meta-analysis.

Results

Seven published studies containing 4 RCTs and 3 CCTs were included for the systematic review. The results of meta-analysis showed that AAT could reduce children’s pain when compared with the control group [MD = −0.53, 95% CI (−0.77, −0.30), P < 0.00001].

Conclusion

Current evidence shows that AAT can relieve pain in children to some extent. Considering the limited quality and quantity of the available studies, more high quality studies should be performed to verify the above conclusion.