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Linkiewich D, Dib KC, Forgeron PA, Dick BD, McMurtry CM. Roadmap to the 'Chronic Pain GPS for Adolescents' Intervention: Content and Design Considerations for a Group Peer Support Intervention. Clin J Pain 2024; 40:288-298. [PMID: 38303597 DOI: 10.1097/ajp.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES A biopsychosocial approach to understanding and treating pain is crucial; however, there are limited socially targeted interventions for adolescents with chronic pain (ACP). Peer support interventions implemented with other populations are associated with positive outcomes. ACPs perceive peer support to have high potential value. This study explored the preferences of ACP regarding the content and design of a group peer support intervention. METHODS Fourteen ACP (M age : 15.21 y; 9 females; 3 males, 1 nonbinary, and 1 gender questioning) completed a virtual interview and survey. Interviews were analyzed using inductive qualitative content analysis, and surveys were analyzed using descriptive statistics. RESULTS Adolescents described how they want to both talk and do activities together within a fun and casual environment with a facilitator present-ideally, someone with lived experience of chronic pain. Preferences were for a medium-sized group intervention that was in-person, at a consistent time on a weekday after school, and semi-structured. Barriers to attending and engaging in the potential group peer intervention were also discussed. DISCUSSION ACPs desire a facilitated socially focused intervention that provides them with the opportunity to spend time with other ACPs. A group peer support environment where ACPs can provide and receive peer support through sharing their experiences with others who understand them as well as engage in activities was described. The findings from this study provide insights for the development of a group peer support intervention.
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Affiliation(s)
| | | | | | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Department of Anesthesia, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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Fournier I, Caron C, McMurtry CM, Lapointe A, Giguere C, Doré-Bergeron MJ, Bergeron M. Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children. Laryngoscope 2024; 134:2422-2429. [PMID: 37800866 DOI: 10.1002/lary.31095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Tympanostomy tube insertion (TTI) is typically accomplished under general anesthesia (GA) in the operating room. We aimed to compare pain between GA and local anesthesia (LA) in surgically naïve children undergoing TTI. Secondary objectives examined patient's quality of life (QoL) and parent's satisfaction. STUDY DESIGN Prospective single-center study. SETTING Tertiary pediatric academic center. METHODS Consecutive children who underwent TTI under GA were compared to patients under LA. Pain standardized observational pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC], Children's hospital of Eastern Ontario Pain Scale [CHEOPS]) were completed pre-procedure, during the first tympanostomy and second tympanostomy, and post-procedure, as well as 1 week postoperatively. General health-related QoL (PedsQL) and QoL specific to otitis media (OM-6) were measured before insertion and 1 month postoperatively. Parental satisfaction was also evaluated using a qualitative scale. RESULTS LA group had statistically significant higher pain levels at the beginning (7.3 vs. 0), during the first tympanostomy (7.8 vs. 0), during the second tympanostomy (7.7 vs. 0), and at end of the procedure (6.9 vs. 0) with the FLACC scale (all p < 0.01). Results were similar with the CHEOPS scale. No pain was noted 1 week after surgery in either group. Both groups had similar improvement in their QoL (p > 0.05). Minor complication occurred at a similar rate (p > 0.05). Parents were equally satisfied with their choice of anesthesia in both groups when initially questioned after the procedure (p > 0.05). CONCLUSIONS Children experienced significantly less pain under GA than LA. If LA is to be used, pain and distress-reducing strategies are critical. Shared decision-making with families is essential. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2422-2429, 2024.
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Affiliation(s)
- Isabelle Fournier
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Camille Caron
- Faculty of Medecine, Université de Montréal, Montreal, Quebec, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Annie Lapointe
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Chantal Giguere
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Marie-Joëlle Doré-Bergeron
- Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Paediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Mathieu Bergeron
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
- Division of Pediatric Otolaryngology-Head and Neck Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
- CHU Sainte Justine Research Institute, CHU Sainte Justine, Montreal, Quebec, Canada
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Gennis HG, Flora DB, McMurtry CM, Flanders D, Weinberg E, Savlov D, Garfield H, Pillai Riddell R. It takes two: The relative contributions of parent versus child-led regulatory behaviours on toddler vaccination pain. Eur J Pain 2024; 28:476-490. [PMID: 37985940 DOI: 10.1002/ejp.2197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/28/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Past research has established the important role of parent soothing in early childhood pain management. However, limited research has assessed children's own emerging emotion regulation strategies to reduce their pain during vaccination. The purpose of the current study was to understand the relative contributions of child-led emotion-regulation behaviours over and above parent regulatory behaviours and pre-needle distress. METHODS Toddler-caregiver dyads were videotaped at their 12- and/or 18-month vaccinations. Videos were coded for pain-related behavioural distress, child-led regulatory behaviours (disengagement of attention, parent-focused behaviours, and physical self-soothing), and parent regulatory/soothing behaviours (distraction, physical comfort, rocking, verbal reassurance). Pre-needle distress, followed by parent regulatory behaviours, followed by child regulatory behaviours were used as hierarchical predictors of pain regulation. Two sets of models were estimated at each age, by incorporating parent and child regulatory behaviours at 1 min and 2 min post-needle, separately. RESULTS At both ages, child-led parent-focused behaviours predicted less regulation. At 18 months, parent soothing behaviours (e.g. distraction, verbal reassurance, rocking) played a stronger role in regulation, however; the only behaviour that increased regulation was rocking. CONCLUSIONS Measuring both parent and child regulatory behaviours was important for fully understanding pain-related distress regulation. Toddlers' use of parent-focused regulatory behaviours (e.g. proximity seeking) suggests that they signal to their parent directly when they are struggling to regulate post-needle. The only parent behaviour that supported this regulation was rocking at 18 months, suggesting a greater need to understand the sensitivity of parent behaviours post-needle. SIGNIFICANCE To our knowledge, this is the first study to examine both parent and child regulatory behaviours following vaccination at different stages in toddlerhood. This investigation allows a deeper understanding of the dyadic nature of early childhood vaccination, as well as the evolving role of the parent through toddlerhood. Importantly, findings suggest that toddlers do not simply wait for their parents to respond to their pain post-needle and provide clear signals to show their need of support in regulation.
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Affiliation(s)
- H G Gennis
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - D B Flora
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - C M McMurtry
- University of Guelph, Guelph, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Western University, London, Ontario, Canada
| | - D Flanders
- University of Toronto, Toronto, Ontario, Canada
| | - E Weinberg
- University of Toronto, Toronto, Ontario, Canada
| | - D Savlov
- University of Toronto, Toronto, Ontario, Canada
| | - H Garfield
- University of Toronto, Toronto, Ontario, Canada
| | - R Pillai Riddell
- Department of Psychology, York University, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Noyek S, Jessa JS, Faulkner V, Boerner KE, Dewan T, Doyle D, Genik L, Grainger-Schatz S, McMorris C, McMurtry CM, Nania CG, Oberlander T, Lorenzetti D, Turner K, Birnie KA. A systematic review of self and observer assessment of pain and related functioning in youth with brain-based developmental disabilities. Pain 2024; 165:523-536. [PMID: 37870234 PMCID: PMC10859851 DOI: 10.1097/j.pain.0000000000003066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 10/24/2023]
Abstract
ABSTRACT Pain experiences of youth with brain-based developmental disabilities are often overlooked and/or misinterpreted, increasing the risk for poor or inadequate pain assessment and management. Ample measures exist to assess acute and chronic pain, yet their utility and frequency of use in youth with brain-based developmental disabilities is unclear and available measures do not have strong measurement properties for this diverse group. This systematic review identified the scope of self-reported and observer-reported pain assessment in studies of youth (aged 3-24 years) with brain-based developmental disabilities (phase 1) and summarized other measures of pain-related functioning for acute and chronic pain (ie, physical, emotional, social, sleep, and quality of life, within the subset of quantitative studies focused primarily on pain, phase 2). A comprehensive search for English-language studies was conducted in August 2022 in Web of Science, CINAHL, MEDLINE, Cochrane CENTRAL, EMBASE, and APA PsychINFO (PROSPERO registration: CRD42021237444). A total of 17,029 unique records were screened. Of the 707 articles included in phase 1, most assessed chronic pain (n = 314; 62.0%) and primarily used observer-report (n = 155; 31%) over self-report (n = 67; 13%). Of the 137 articles included in phase 2, other outcomes assessed alongside pain intensity included motor ability (16.8%), adaptive functioning (11%), quality of life (8%), pain interference (6.6%), mental health (5.8%), and communication ability (2.9%). Cerebral palsy was the most common population in both phase 1 (n = 343; 48.5%) and phase 2 (n = 83; 59.7%). This review provides a foundational understanding of pain assessment in brain-based developmental disabilities and highlights continued inequities in holistic pain assessment for this population.
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Affiliation(s)
- Samantha Noyek
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jenna S. Jessa
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Violeta Faulkner
- Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
| | | | - Tammie Dewan
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dacey Doyle
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of British Columbia, BC, Canada
- Department of Psychology, University of Guelph, ON, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of British Columbia, BC, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, AB, Canada
| | - Lara Genik
- Department of Psychology, University of Guelph, ON, Canada
| | - Stacy Grainger-Schatz
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of British Columbia, BC, Canada
- Department of Psychology, University of Guelph, ON, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of British Columbia, BC, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, AB, Canada
| | - Carly McMorris
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | | | - Cara G. Nania
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Tim Oberlander
- Department of Pediatrics, University of British Columbia, BC, Canada
| | - Diane Lorenzetti
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kailyn Turner
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Kathryn A. Birnie
- Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, AB, Canada
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Lee S, Tomlinson R, Lumley MN, Bax KC, Ashok D, McMurtry CM. Positive Schemas, Coping, and Quality of Life in Pediatric Recurrent Abdominal Pain. J Clin Psychol Med Settings 2024; 31:37-47. [PMID: 36952113 DOI: 10.1007/s10880-023-09952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/24/2023]
Abstract
Pediatric recurrent abdominal pain is commonly associated with negative impacts on quality of life (QOL). Positive schemas (core beliefs about the self with subthemes of self-efficacy, optimism, trust, success, and worthiness) are a resilience factor that has not yet been examined within a pediatric recurrent pain context. This cross-sectional study examined (a) associations between positive schemas, pain coping, and youth QOL, and (b) exploratory analyses to investigate whether specific positive schema subthemes predicted QOL outcomes in youth with recurrent abdominal pain. Participants were 98 youth with recurrent abdominal pain (i.e., pain related to a disorder of gut-brain interaction [DGBI] or organic cause) who completed measures on positive schemas, QOL, and pain coping. Age and diagnostic status were controlled for in analyses. Positive schemas were significantly positively correlated with emotional, social, school, and overall QOL, as well as with approach and problem-focused avoidant coping, and significantly negatively correlated with emotion-focused coping. Worthiness was the strongest and only significant predictor of youth social functioning. Positive schemas may be an important cognitive resilience factor to consider within interventions for pediatric recurrent pain.
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Affiliation(s)
- Soeun Lee
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Rachel Tomlinson
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Margaret N Lumley
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kevin C Bax
- Department of Paediatrics, Western University, London, ON, Canada
| | - Dhandapani Ashok
- Department of Paediatrics, Western University, London, ON, Canada
| | - C Meghan McMurtry
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
- Department of Paediatrics, Western University, London, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Children's Health Research Institute, London, ON, Canada
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Taddio A, Coldham J, Logeman C, McMurtry CM, Bucci LM, Gudzak V, MacDonald NE, Little C, Samborn T, Moineddin R. CARD (Comfort Ask Relax Distract) for school-based immunizations in Calgary, Canada: a pragmatic cluster trial. Pain 2024; 165:644-656. [PMID: 37824173 PMCID: PMC10859848 DOI: 10.1097/j.pain.0000000000003050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
ABSTRACT School-based immunizations are fear-inducing events for many students and contribute to vaccine hesitancy. We developed an immunization delivery framework called the CARD (Comfort Ask Relax Distract) system that incorporates evidence-based interventions to improve the experience (eg, reduce fear, pain, dizziness). We evaluated CARD in grades 6 and 9 students in Calgary, Canada. In this pragmatic, hybrid, effectiveness-implementation, cluster trial, we randomized 8 Community Health Centres providing regional immunization services to CARD or control (usual care). In the CARD group, public health staff educated students about CARD and planned processes to reduce fear cues and support student coping choices during immunization. Students self-reported fear, pain, and dizziness during immunization using a 0-10 numerical rating scale; staff recorded procedure details, including vaccines administered, fainting episodes, and coping strategies used. Staff participated in focus groups afterward. Altogether, 8839 children from 105 schools in the 2019 to 2020 school calendar year were included. Fear was lower for CARD (mean = 3.6 [SD = 3.1] vs control 4.1 [3.2]; mean difference = -0.5; 95% confidence interval = -0.74 to -0.21; P < 0.001). Effectiveness persisted after stratification by student gender (male and female) and grade level (grade 6 and grade 9). Other symptoms did not differ. Compared with control, CARD students used peers, privacy, muscle tension, and topical anesthetics more; verbal distraction, deep breathing, and adult support were used less frequently ( P < 0.05, all analyses). Immunization rate did not differ. Staff reported positive to neutral attitudes about CARD. In summary, this pragmatic trial demonstrated that CARD improved the immunization experiences of students at school.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Charlotte Logeman
- Child Health Evaluative Services, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Lucie M. Bucci
- Bucci-Hepworth Health Services Inc., Pincourt, QC, Canada
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Noni E. MacDonald
- Faculty of Medicine, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | | | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, Cochrane, AL, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Lee S, Jordan A, Walker N, Nauman H, Dick B, McMurtry CM. Learning, Hope, and Empowerment: A Reflexive Thematic Analysis of Feedback on a Group Intervention for Parents of Youth With Chronic Pain. Clin J Pain 2023; 39:611-619. [PMID: 37440336 DOI: 10.1097/ajp.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Limited research has investigated parent-targeted interventions in pediatric chronic pain, though these interventions may be an important part of family-centered care. Further, parent perspectives and feedback regarding these interventions are scant in the literature, even though they are crucial for developing, refining, and optimizing treatment options. This study aimed to understand how parents experience and perceive their participation in a cognitive-behavioral therapy-based, parent-targeted group intervention that was delivered either in-person or virtually, with a focus on the treatment components they found most important. METHODS Data from semistructured focus groups/interviews within 1week post-treatment with 32 parents (n=11 in-person, n=21 virtual) were analyzed using an inductive reflexive thematic analysis. RESULTS Three overarching themes were generated from the thematic analysis: building a foundation of knowledge, finding normalization and hope through connection and lived experiences, and sharing collective responsibility for pain management. DISCUSSION Parents perceived a range of benefits from participating in a cognitive-behavioral therapy-based, parent-targeted group intervention, both on themselves and for their youth. Overall, parent perceptions across in-person and virtual intervention delivery were consistent, except for a drawback of virtual participation for developing a deeper social connection among parents. Thus, a relatively brief parent-targeted group intervention was perceived to be a positive experience for parents, though considerations for adapting to virtual delivery and facilitating social connection among parents seem to be important.
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Affiliation(s)
- Soeun Lee
- Department of Psychology, University of Guelph, Guelph
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | | | - Hiba Nauman
- Department of Psychology, University of Guelph, Guelph
| | - Bruce Dick
- Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta
- Pediatric Chronic Pain Clinic, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Pediatric Chronic Pain Program, McMaster Children's Hospital
- Department of Anesthesia, McMaster University, Hamilton, ON
- Children's Health Research Institute and Department of Pediatrics, Schulich School of Medicine and Dentistry, London, ON
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Linkiewich D, Dib KC, Forgeron PA, Dick BD, McMurtry CM. Perceptions of Adolescents With Chronic Pain About Peer Support: Reflexive Thematic Analysis. J Pediatr Psychol 2023; 48:655-663. [PMID: 36860181 DOI: 10.1093/jpepsy/jsad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE Social challenges are a common experience for adolescents with chronic pain. Group peer support for these adolescents could be a promising intervention; however, no studies have focused exclusively on the peer support needs of this population. The present study addressed this gap in the literature. METHODS Adolescents with chronic pain between 12 and 17 years of age completed a virtual interview and demographics questionnaire. Interviews were analyzed using inductive reflexive thematic analysis. RESULTS Fourteen adolescents (Mage: 15.21 years; 9 females; 3 males, 1 nonbinary, 1 gender questioning) with chronic pain participated. Three themes were generated: "Being Misunderstood," "They Would Understand Me," and "Moving Forward Together in Our Pain Journeys." Adolescents with chronic pain feel misunderstood and under supported by their peers without pain leading to feeling "othered" by having to explain their pain, yet not feeling free to talk about their pain with friends. Adolescents with chronic pain expressed that peer support would provide the forms of social support they are missing amongst their friends without pain as well as companionship and a sense of belonging due to shared knowledge and experiences. CONCLUSIONS Adolescents with chronic pain desire peer support from others like themselves, highlighting the challenges in their everyday friendships as the impetus for this support, as well as their anticipated short- and long-term benefits, including learning from their peers and developing new friendships. Findings indicate that adolescents with chronic pain may benefit from group peer support. Findings will inform the development of a peer support intervention for this population.
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Affiliation(s)
| | | | | | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Stollery Children's Hospital, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Canada
- McMaster Children's Hospital and Department of Anaesthesia, McMaster University, Canada
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Nauman H, Dobson O, Taddio A, Birnie KA, McMurtry CM. Picturing Bravery: A Rapid Review of Needle Procedures Depicted in Children's Picture Books. Children (Basel) 2023; 10:1097. [PMID: 37508594 PMCID: PMC10377774 DOI: 10.3390/children10071097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 07/30/2023]
Abstract
Existing research has identified evidence-based strategies for mitigating fear and pain during needle procedures; yet, families often experience limited access to health professionals who deliver these interventions. Children may benefit from learning about such strategies in a developmentally appropriate and accessible format such as a picture book. This review aimed to summarize content related to needle procedures represented in picture books for 5- to 8-year-old children. Key terms were searched on Amazon, and the website was used to screen for relevant eligibility criteria. Three levels of screening and exclusions resulted in a final sample of 48 books. Quantitative content analysis was used to apply a coding scheme developed based on relevant Clinical Practice Guidelines and systematic reviews. Cohen's Kappa indicated strong reliability, and frequencies were calculated to summarize the content. The books were published between 1981 and 2022. All 48 books included at least one evidence-based coping strategy. Distressing aspects such as scary visuals were often included (27.1%), as well as specific expressions of fear (52.1%) and pain (16.7%). Overall, this study paves the way for researchers interested in evaluating the effectiveness of picture books on children's knowledge and self-efficacy, as well as creating interventions for coping.
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Affiliation(s)
- Hiba Nauman
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Olivia Dobson
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Pediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON L8N 3Z5, Canada
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Gennis HG, Flora DB, Norton L, McMurtry CM, Merlano TE, Zaghi A, Flanders D, Weinberg E, Savlov D, Garfield H, Pillai Riddell RR. Understanding the concurrent and predictive relations between child-led emotion regulation behaviors and pain during vaccination in toddlerhood. Pain 2023; 164:1291-1302. [PMID: 36661189 DOI: 10.1097/j.pain.0000000000002816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/31/2022] [Indexed: 01/21/2023]
Abstract
ABSTRACT The purpose of this study was to further our understanding of early childhood pain-related distress regulation. Concurrent and predictive relations between child-led emotion regulation (ER) behaviors and pain-related distress during vaccination were examined at 2 different ages using autoregressive cross-lagged path analyses. Toddlers were video-recorded at the 12- and 18-month routine vaccination appointments (12-month-old [N = 163]; 18-month-old [N = 149]). At 1, 2, and 3 minutes postneedle, videos were coded for 3 clusters of child-led ER behaviors (disengagement of attention, parent-focused behaviors, and physical self-soothing) and pain-related distress. The concurrent and predictive relations between child-led ER behaviors and pain-related distress behaviors were assessed using 6 models (3 emotion regulation behaviors by 2 ages). At 18 months, disengagement of attention was significantly negatively related to pain-related distress at 1 minute postneedle, and pain-related distress at 1 minute postneedle was significantly related to less disengagement of attention at 2 minutes postneedle. Parent-focused behaviors had significant positive relations with pain-related distress at both ages, with stronger magnitudes at 18 months. Physical self-soothing was significantly related to less pain-related distress at both ages. Taken together, these findings suggest that disengagement of attention and physical self-soothing may serve more of a regulatory function during toddlerhood, whereas parent-focused behaviors may serve more of a function of gaining parent support for regulation. This study is the first to assess these relations during routine vaccination in toddlerhood and suggests that toddlers in the second year of life are beginning to play a bigger role in their own regulation from painful procedures than earlier in infancy.
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Affiliation(s)
| | | | | | - C Meghan McMurtry
- University of Guelph, Guelph, ON, Canada
- McMaster Children's Hospital, Hamilton, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Western University, London, ON, Canada
| | | | | | | | | | | | - Hartley Garfield
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Rebecca R Pillai Riddell
- York University, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
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11
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Mastrella SJ, Powell DM, Bonaccio S, McMurtry CM. The Impact of Interviewees’ Anxious Nonverbal Behavior on Interview Performance Ratings. Journal of Personnel Psychology 2023. [DOI: 10.1027/1866-5888/a000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Abstract. Interview anxiety is correlated with lower interview performance ratings, but it is unclear why. This study examined the impact of interviewees’ anxious nonverbal behavior on interview performance ratings. Additionally, the amount of interpersonal interaction in the job and interviewee gender were examined as moderators. Participants ( N = 823) watched a video recording of an actor delivering scripted responses to interview questions. Hypotheses were tested using a between-subjects design. Participants in the high anxious nonverbal behavior condition gave lower interview performance ratings than those in the low anxious nonverbal behavior condition. Job type and interviewee gender did not moderate this relation. Thus, interviewees’ anxious nonverbal behavior may explain why interview anxiety is correlated with lower interview performance ratings.
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Affiliation(s)
| | | | - Silvia Bonaccio
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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12
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Constantin KL, Lupo-Flewelling K, Moline RL, McMurtry CM. Child Emotion Regulation Capacity Moderates the Association Between Parent Behaviors and Child Distress During Pediatric Venipuncture. J Pediatr Psychol 2023; 48:108-119. [PMID: 35438772 DOI: 10.1093/jpepsy/jsac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Medical needle procedures are a common source of pain, distress, and fear for children, which can worsen over time and lead to needle noncompliance and avoidance, if unaddressed. Children's pain experience is multiply determined by external (e.g., parent behaviors) and internal (e.g., cognitive and affective) factors. Some parent behaviors (e.g., reassurance, giving control to child, empathy, apologies, criticism) have related to poor child pain experiences. No research has examined how children's internal emotion regulation, commonly measured via heart rate variability (HRV), may buffer, or strengthen this association. This study is the first to examine child HRV in relation to pain experiences, and as a moderator between a constellation of parent behaviors (reassurance, giving control, empathy) and child pain, fear, and distress. METHODS Sixty-one children aged 7-12 years undergoing venipuncture and a parent participated. Child HRV was measured before the procedure. After venipuncture, children rated their pain and fear. Parent and child behaviors during venipuncture were coded using the "distress promoting" and "distress" composites of the Child-Adult Medical Procedure Interaction Scale-Revised. RESULTS Children with lower HRV displayed greater distress. Child HRV moderated the positive association between parent behaviors (reassurance, giving control, empathy) and child distress such that the association was strongest among children with low HRV. CONCLUSIONS Findings suggest children with lower HRV, indicative of lower emotion regulation capacity, may be at risk of experiencing higher levels of distress and may be more vulnerable to distress when facing parent reassurance, giving control, and empathy verbalizations during venipuncture.
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Affiliation(s)
| | | | | | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Canada.,Pediatric Chronic Pain Program, McMaster Children's Hospital, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, Canada
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13
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Taddio A, Rocchi M, Bucci LM, McMurtry CM, LeDrew E, Shea C, Morrison J, Yang M, Gudzak V, Logeman C, MacDonald NE. CARD (Comfort Ask Relax Distract) integration guide for community pharmacies administering vaccinations: How to play your best hand. Can Pharm J (Ott) 2022; 156:56S-61S. [PMID: 36756628 PMCID: PMC9899972 DOI: 10.1177/17151635221139193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | - Marie Rocchi
- the Leslie Dan Faculty of Pharmacy, University
of Toronto
| | | | - C. Meghan McMurtry
- the Department of Psychology, University of
Guelph,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton,Children’s Health Research Institute,
Guelph
| | - Erin LeDrew
- TIDES & Community Education, Centre for
Addiction and Mental Health, Toronto
| | - Christine Shea
- the Institute of Health Policy, Management and
Evaluation, University of Toronto,Institute of Health Policy, Management and
Evaluation, University of Toronto
| | | | - Molly Yang
- Wholehealth Pharmacy Partners, Markham,
Ontario
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14
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Taddio A, Morrison J, Gudzak V, Logeman C, McMurtry CM, Bucci LM, Shea C, MacDonald NE, Yang M. Integration of CARD (Comfort Ask Relax Distract) for COVID-19 community pharmacy vaccination in children: Effect on implementation outcomes. Can Pharm J (Ott) 2022; 156:36S-47S. [PMID: 36748084 PMCID: PMC9755037 DOI: 10.1177/17151635221139783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
Introduction Community pharmacists report that providing vaccinations can be challenging, particularly if the vaccine recipient is a child, because of heightened levels of fear. The objective of this study was to determine acceptability and feasibility of the CARD (Comfort Ask Relax Distract) system as a vaccination delivery framework for children receiving COVID-19 vaccinations in a community pharmacy setting. CARD incorporates evidence-based interventions that reduce fear and immunization stress-related responses in vaccine recipients and was demonstrated to be effective and feasible in other vaccination settings providing vaccinations to children and adults. Methods This mixed-methods study involved 5 independent pharmacies (with 6 vaccinators) offering COVID-19 vaccinations to children between 5 and 11 years of age. Vaccinating staff and implementation leads from the pharmacy organization participated in a small-scale CARD implementation project (before-and-after design). Afterwards, they filled in quantitative surveys and provided qualitative feedback about their perceptions and experiences in focus group discussions. Qualitative data were analyzed deductively, using the Consolidated Framework for Implementation Research (CFIR). Results The study was conducted between January 16 and March 20, 2022. Across both quantitative and qualitative measures, vaccinating staff reported positive attitudes about CARD and alignment with their professional roles. They reported that CARD reduced children's fear and improved the vaccination experiences in children and parents and for themselves. Vaccinators reported increased confidence due to CARD. They reported compatibility of CARD interventions within their practice and that it was time neutral. They maintained use of some interventions after the study. They also provided suggestions and shared concerns about fidelity and future feasibility of continuing various components of the program. Conclusion CARD was demonstrated to be acceptable and feasible by vaccinators performing vaccinations in children in community pharmacies.
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Affiliation(s)
| | | | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of
Toronto, Ontario
| | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph,
Ontario,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton, Ontario,Children’s Health Research Institute, Guelph,
Ontario
| | - Lucie M. Bucci
- Immunize Canada, Canadian Public Health
Association, Ottawa, Ontario
| | - Christine Shea
- Institute of Health Policy, Management and
Evaluation, University of Toronto, Ontario
| | | | - Molly Yang
- Wholehealth Pharmacy Partners, Markham,
Ontario
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15
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Taddio A, Ilersich ANT, Bucci L, McMurtry CM, Gudzak V, Ipp M, Zita T, Tharmarajah S, MacDonald N. Letting kids play their CARDs (Comfort, Ask, Relax, Distract) to help cope with needle-related fear and pain: Results from user testing. Vaccine 2022; 40:7667-7675. [PMID: 36372667 DOI: 10.1016/j.vaccine.2022.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022]
Abstract
This study examined perceptions of children and parents about a new web-based CARD (Comfort, Ask, Relax, Distract) game that teaches children how to cope with needle-related pain and fear. A convenience sample of 15 child-parent dyads (children, 6-12 years) participated. Children played the game on a handheld device while being virtually monitored. Activity tracking revealed most children engaged with multiple components. Children reported they understood the game, it was easy to play, they learned coping strategies and believed they could implement them. Children reported lower fear of needles after playing. Parents liked the simplicity and variety of game activities. Most children and parents reported they would use the game or its coping strategies for future needles and would recommend the game. In summary, children and parents found the CARD web game acceptable and appropriate. Future studies can evaluate its effectiveness when integrated into upcoming needle procedures like COVID-19 vaccinations.
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada.
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph; Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
| | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Moshe Ipp
- Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Tina Zita
- Peel District School Board, Mississauga, Canada.
| | - Shenthuraan Tharmarajah
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Noni MacDonald
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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16
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Taddio A, McMurtry CM, Logeman C, Gudzak V, de Boer A, Constantin K, Lee S, Moline R, Uleryk E, Chera T, MacDonald NE, Pham B. Prevalence of pain and fear as barriers to vaccination in children - Systematic review and meta-analysis. Vaccine 2022; 40:7526-7537. [PMID: 36283899 DOI: 10.1016/j.vaccine.2022.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Injection-related pain and fear are common adverse reactions in children undergoing vaccination and influence vaccine acceptance. Despite the large body of literature on sources of vaccine non-compliance, there is no estimate of the prevalence of pain and fear as contributing factors. The objective was to estimate the prevalence of injection pain or fear of needles as barriers to childhood (i.e., 0-18 years) vaccination. METHODS Four databases were searched from inception for relevant English and French articles until August 2021. In addition, the references of recent systematic reviews and all articles included in the review were hand searched. Article screening and data extractions were performed in duplicate. Studies were included if they reported on injection-related pain or fear of needles in children (0-18 years) using a checklist/closed-ended question(s). Results were stratified by respondent (parents or children), type of pediatric population (general or under-vaccinated), and relative importance of barrier (pain or needle fear as primary reason or any reason for under-vaccination). Prevalence rates of pain or needle fear were combined using a random effects model. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence data. Quality across studies was assessed using GRADE. RESULTS There were 26 studies with 45 prevalence estimates published between 1995 and 2021. For parent reports (of children) and children self-reported reasons for non-compliance, prevalence rates of pain or needle fear ranged from 5 to 13% in a general population and 8 to 28% in an under-vaccinated population, with a substantial variation in the prevalence estimates. There was no difference between category of respondent or relative importance on pain or needle fear prevalence rate. A regression model demonstrated an overall prevalence rate of pain or needle fear as an obstacle to vaccination of 8% in the general population and 18.3% in the under-vaccinated population. All evidence was very low in quality. CONCLUSION This is the first review to systematically quantify the prevalence and therefore, importance, of pain and needle fear as obstacles to vaccination in children around the world. Pain from injection or fear of needles were demonstrated to be sufficiently prevalent as barriers to vaccination in children to warrant attention. Addressing pain and fear has the potential to significantly improve vaccination acceptance.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, and Child Health Evaluative Sciences, The Hospital for Sick Children (SickKids), Toronto, Canada.
| | | | | | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Adrian de Boer
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Soeun Lee
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Rachel Moline
- Department of Psychology, University of Guelph, Guelph, Canada
| | | | | | | | - Ba' Pham
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
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17
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Taddio A, Morrison J, Gudzak V, Logeman C, McMurtry CM, Bucci LM, Shea C, MacDonald NE, Yang M. CARD (Comfort Ask Relax Distract) for community pharmacy vaccinations in children: Effect on immunization stress-related responses and satisfaction. Can Pharm J (Ott) 2022; 156:27S-35S. [PMID: 36756630 PMCID: PMC9899969 DOI: 10.1177/17151635221137682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD's clinical impact when integrated into community pharmacy-based pediatric vaccinations. Methods This was a before-and-after CARD implementation study in 5 independent pharmacies offering COVID-19 vaccinations to children aged 5-11 years. No changes were made to practices in the "before" phase. CARD interventions were integrated in the "after" phase (e.g., children prepared a coping plan using a checklist, distraction toolkits were placed in waiting and vaccination spaces, vaccinations were performed with privacy, needles were obscured). Children self-reported ISRR, including fear, pain and dizziness during vaccination, and both children and parents/caregivers (herein, parents) compared the child's experience to their last needle (better, same, worse). In the "after" phase, parents and children reported how much CARD helped (not at all, a little bit, a moderate amount, a lot). Results The study was conducted between January 16 and March 20, 2022. Altogether, 152 children participated (71 before and 81 after CARD); demographic characteristics did not differ. Children's self-reported fear was lower after CARD, when assessed continuously (2.5 vs 3.7 out of 10; p = 0.02) or dichotomously, using a cut-off of 0 vs >0 (58% vs 80%; p = 0.01). Pain was lower when assessed dichotomously (<2 vs ≥2; p = 0.03). There was no difference in dizziness. After CARD, children and parents reported more positive experiences compared to the child's last needle (p = 0.01, both analyses) and more children and parents reported that distraction and child participation in the process were helpful (p < 0.001, both analyses). Overall, 92% of children and 91% of parents said CARD helped. Conclusion CARD reduced children's fear and improved vaccination experiences for children and parents when integrated in community pharmacy-based vaccinations.
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Affiliation(s)
| | | | | | | | - C. Meghan McMurtry
- Department of Psychology, University of
Guelph,Pediatric Chronic Pain Program, McMaster
Children’s Hospital, Hamilton,Children’s Health Research Institute, Guelph,
Ontario
| | | | - Christine Shea
- Institute of Health Policy, Management and
Evaluation, University of Toronto,Institute of Health Policy, Management and
Evaluation, University of Toronto, Ontario
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18
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Modabber M, Campbell KM, McMurtry CM, Taddio A, Dempster LJ. Children's Perceptions of Dental Experiences and Ways to Improve Them. Children (Basel) 2022; 9:children9111657. [PMID: 36360385 PMCID: PMC9688229 DOI: 10.3390/children9111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023]
Abstract
This qualitative study explored children's perceptions of their dental experiences and their acceptability of the CARD™ (Comfort, Ask, Relax, Distract) system, adapted for the dental setting as a means to mitigate dental fear and anxiety (DFA). A purposive sample of 12 participants (7 males) aged 8-12 years receiving dental care at the Paediatric Dental Clinic, University of Toronto, was recruited. Virtual one-on-one interviews were augmented with visual aids. Participants were oriented to and asked about their perceptions of various dental procedures. Data were deductively analyzed, according to the Person-Centered Care framework (PCC). Four themes were identified: establishing a therapeutic relationship, shared power and responsibility, getting to know the person and empowering the person. Children emphasized the importance of clinic staff attributes and communication skills. They expressed a desire to engage more actively in their own care and highlighted the positive influence of pre-operative education and preparation. Participants found the CARD™ system to facilitate opportunities for self-advocacy in their dental care.
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Affiliation(s)
- Melika Modabber
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
| | - Karen M. Campbell
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Laura J. Dempster
- Faculty of Dentistry, University of Toronto, Toronto, ON M5G 1X3, Canada
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19
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Constantin KL, Moline RL, Pillai Riddell R, Spence JR, Fiacconi CM, Lupo‐Flewelling K, McMurtry CM. Parent and child self‐ and co‐regulation during pediatric venipuncture: Exploring heart rate variability and the effects of a mindfulness intervention. Dev Psychobiol 2022; 64:e22277. [DOI: 10.1002/dev.22277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/25/2022] [Accepted: 03/20/2022] [Indexed: 12/21/2022]
Affiliation(s)
| | - Rachel L. Moline
- Department of Psychology University of Guelph Guelph Ontario Canada
| | - Rebecca Pillai Riddell
- Department of Psychology York University Toronto Ontario Canada
- Department of Psychiatry Research The Hospital for Sick Children Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | | | | | | | - C. Meghan McMurtry
- Department of Psychology University of Guelph Guelph Ontario Canada
- Pediatric Chronic Pain Program McMaster Children's Hospital Hamilton Ontario Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry Western University London Ontario Canada
- Department of Anesthesia McMaster University Hamilton Ontario Canada
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20
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Caes L, McMurtry CM, Duncan CL. Editorial: Coping With the Pediatric Coping Literature: Innovative Approaches to Move the Field Forward. Front Psychol 2022; 13:885679. [PMID: 35422732 PMCID: PMC9002007 DOI: 10.3389/fpsyg.2022.885679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Scotland, United Kingdom
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON, Canada.,McMaster Children's Hospital, Hamilton, ON, Canada
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV, United States
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21
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Gennis HG, Bucsea O, Badovinac SD, Costa S, McMurtry CM, Flora DB, Pillai Riddell R. Child Distress Expression and Regulation Behaviors: A Systematic Review and Meta-Analysis. Children (Basel) 2022; 9:174. [PMID: 35204895 PMCID: PMC8870305 DOI: 10.3390/children9020174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
The goal of the current study was to review and meta-analyze the literature on relationships between child distress expression behaviors (e.g., cry) and three clusters of child distress regulation behaviors (disengagement of attention, parent-focused behaviors, and self-soothing) in the first three years of life. This review was registered with PROSPERO (CRD42020157505). Unique abstracts were identified through Medline, Embase, and PsycINFO (n = 13,239), and 295 studies were selected for full-text review. Studies were included if they provided data from infants or toddlers in a distress task, had distinct behavioral measures of distress expression and one of the three distress regulation clusters, and assessed the concurrent association between them. Thirty-one studies were included in the meta-analysis and rated on quality. Nine separate meta-analyses were conducted, stratified by child age (first, second, and third year) and regulation behavior clusters (disengagement of attention, parent-focused, and self-soothing). The weighted mean correlations for disengagement of attention behaviors were -0.28 (year 1), -0.44 (year 2), and -0.30 (year 3). For parent-focused behaviors, the weighted mean effects were 0.00 (year 1), 0.20 (year 2), and 0.11 (year 3). Finally, the weighted mean effects for self-soothing behaviors were -0.23 (year 1), 0.25 (year 2), and -0.10 (year 3). The second year of life showed the strongest relationships, although heterogeneity of effects was substantial across the analyses. Limitations include only analyzing concurrent relationships and lack of naturalistic distress paradigms in the literature.
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Affiliation(s)
- Hannah G. Gennis
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
| | - Oana Bucsea
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
| | - Shaylea D. Badovinac
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
| | - Stefano Costa
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada;
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
- Children’s Health Research Institute, 345 Westminster Avenue, London, ON N6C 4V3, Canada
- Department of Pediatrics, Western University, 800 Commissioners Road East, London, ON N6A 5W9, Canada
| | - David B. Flora
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
| | - Rebecca Pillai Riddell
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada; (H.G.G.); (O.B.); (S.D.B.); (S.C.); (D.B.F.)
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Department of Psychiatry Research, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5T IR8, Canada
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22
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Edwards KR, McMurtry CM, Dick B, Lewinson R, Dhariwal A, Katz J. Somatic symptom disorder, conversion disorder, and chronic pain: Pediatric clinician perspectives. Clinical Practice in Pediatric Psychology 2021. [DOI: 10.1037/cpp0000377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee S, Dick BD, Jordan A, McMurtry CM. Psychological Interventions for Parents of Youth With Chronic Pain: A Scoping Review. Clin J Pain 2021; 37:825-844. [PMID: 34475341 DOI: 10.1097/ajp.0000000000000977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/19/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Parents are integral to their youth's chronic pain experiences, and intervening with parents may improve parent and youth functioning. Existing systematic reviews are not specific to pain or do not systematically report critical aspects to facilitate implementation of parent interventions in diverse settings. Thus, this scoping review aimed to map published parent interventions for pediatric chronic pain to summarize the participant and intervention characteristics, treatment components, methods, outcomes, feasibility, and acceptability, as well as identify gaps for future research. METHODS Four databases were searched (PubMed, PsycINFO, CINAHL, and Google Scholar). Studies of any design reporting psychological interventions including parents of youth (0 to 18 y) with chronic pain were included. Data on study characteristics, treatment components, effectiveness, and feasibility/acceptability were extracted. RESULTS Fifty-four studies met inclusion criteria from 9312 unique titles. The majority were nonrandomized cognitive-behavioral therapy interventions delivered individually. The degree of parent participation ranged from 17% to 100%; the average enrollment rate was 68%. Reported parent and youth outcomes were variable; 26% of studies did not include any parent-related outcomes. DISCUSSION Parent interventions may be a helpful and feasible way to support parents and youth with chronic pain. There is variability across study characteristics, treatment content/aims, parent participation, and parent/youth outcomes.
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Affiliation(s)
- Soeun Lee
- Department of Psychology, University of Guelph, Guelph
| | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta
- Pediatric Chronic Pain Clinic, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Abbie Jordan
- Department of Psychology and Bath Centre for Pain Research, University of Bath, Bath, UK
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton
- Children's Health Research Institute and Department of Pediatrics, Schulich School of Medicine and Dentistry, London, ON
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Nabbijohn AN, Tomlinson RM, Lee S, Morrongiello BA, McMurtry CM. The Measurement and Conceptualization of Coping Responses in Pediatric Chronic Pain Populations: A Scoping Review. Front Psychol 2021; 12:680277. [PMID: 34659002 PMCID: PMC8519346 DOI: 10.3389/fpsyg.2021.680277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Pediatric chronic pain is a prevalent condition that requires significant coping to encourage optimal functioning; however, relevant research is vast, heterogeneous, and difficult to interpret. To date, no attempt has been made to map and summarize the measurement and conceptualization of coping responses in the context of pediatric chronic pain. Objectives: A scoping review was conducted to map and summarize the participant characteristics, methodologies, theoretical frameworks, and measures used to assess coping responses in youth with chronic pain. The extent to which authors used definitions and examples of coping responses (conceptual clarity) as well as consistently used measures (measurement consistency) and their corresponding conceptualizations (conceptual consistency) relative to how they were intended to be used were assessed. Methods: Searches were conducted through MEDLINE (PubMed) and PsycINFO. Following title/abstract screening, full-text extractions were performed on 125 English-language publications on coping in youth with chronic pain. Results: Of the 125 studies, only 12.8% used a theoretical framework to explain the coping responses assessed, and even fewer (7.2%) used theory to guide measure selection. Conceptual clarity was rated "low/very low" (i.e., no definitions and/or examples) for 47.2% of studies. The majority of studies were conducted in the United States (67%) and a preponderance of White and female participants was sampled. The research primarily used quantitative methods (85%) and cross-sectional designs (67%). Parent- or self-report questionnaires were the most common methods for assessing coping (86%). Of the 95 studies that utilized one of the 14 questionnaires with known psychometric properties, 33.7 and 55.8% had one or more discrepancies for conceptual and measurement consistency, respectively. Conclusions: This review highlights the lack of clear descriptions and theoretical frameworks of coping responses for pediatric chronic pain. Inconsistencies in the measurement and conceptualization of coping responses limit research and clinical advancements. As a field, we need to strive toward using well-developed theory to create fewer, more well-established standardized measures with clearly defined coping responses. Opportunities for qualitative and observational research in more diverse patient populations should be considered for theory construction and measure validation. Clinical Trial Registration: https://osf.io/xvn2a/?view_only=eff04e0c0b9649be89d403b10e9ff082.
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Affiliation(s)
| | | | - Soeun Lee
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
- Children's Health Research Institute and Department of Paediatrics, Schulich School of Medicine and Dentistry, London, ON, Canada
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Moline RL, McMurtry CM, Noel M, McGrath PJ, Chambers CT. Parent–child interactions during pediatric venipuncture: Investigating the role of parent traits, beliefs, and behaviors in relation to child outcomes. Can J Pain 2021. [DOI: 10.1080/24740527.2021.1952065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Rachel L. Moline
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, Ontario, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute
| | - Patrick J. McGrath
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
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O'Doherty KC, Crann S, Bucci LM, Burgess MM, Chauhan A, Goldenberg MJ, McMurtry CM, White J, Willison DJ. Deliberation on Childhood Vaccination in Canada: Public Input on Ethical Trade-Offs in Vaccination Policy. AJOB Empir Bioeth 2021; 12:253-265. [PMID: 34328070 DOI: 10.1080/23294515.2021.1941416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Policy decisions about childhood vaccination require consideration of multiple, sometimes conflicting, public health and ethical imperatives. Examples of these decisions are whether vaccination should be mandatory and, if so, whether to allow for non-medical exemptions. In this article we argue that these policy decisions go beyond typical public health mandates and therefore require democratic input. METHODS We report on the design, implementation, and results of a deliberative public forum convened over four days in Ontario, Canada, on the topic of childhood vaccination. RESULTS 25 participants completed all four days of deliberation and collectively developed 20 policy recommendations on issues relating to mandatory vaccinations and exemptions, communication about vaccines and vaccination, and AEFI (adverse events following immunization) compensation and reporting. Notable recommendations include unanimous support for mandatory childhood vaccination in Ontario, the need for broad educational communication about vaccination, and the development of a no-fault compensation scheme for AEFIs. There was persistent disagreement among deliberants about the form of exemptions from vaccination (conscience, religious beliefs) that should be permissible, as well as appropriate consequences if parents do not vaccinate their children. CONCLUSIONS We conclude that conducting deliberative democratic processes on topics that are polarizing and controversial is viable and should be further developed and implemented to support democratically legitimate and trustworthy policy about childhood vaccination.
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Affiliation(s)
| | - Sara Crann
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Lucie Marisa Bucci
- Immunize Canada, c/o Canadian Public Health Association, Ottawa, Ontario, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Apurv Chauhan
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, Ontario, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Jessica White
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donald J Willison
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Genik LM, Aerts EL, Nauman H, Barney CC, Lewis SP, McMurtry CM. A Randomized Controlled Trial Evaluating a Pain Training for Respite Workers Supporting Children With Disabilities Part Two: Training Evaluations and the Impact of Training on Knowledge Application. Am J Intellect Dev Disabil 2021; 126:289-306. [PMID: 34161564 DOI: 10.1352/1944-7558-126.4.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/13/2021] [Indexed: 06/13/2023]
Abstract
Within a parallel-group randomized control trial, pain training's impact on Respite Workers' (RW) care approaches and training evaluations was explored. RW (n = 158) from 14 organizations received pain or control training following randomization. Researchers were blind until randomization; allocations were not shared explicitly with organizations/participants. Participants completed a strategy use questionnaire immediately before and an evaluation immediately after training completion. Four-to-6 weeks later, participants completed the strategy use questionnaire and semistructured focus groups. No differences in pain approaches were noted in strategy use questionnaires. Per focus groups, both groups acquired a "knowing" about pain and applied pain-related care approaches in similarly. Pain training participants identified need for "growing and strengthening" pain knowledge. Training endorsements were favorable. RW pain training has value and may impact practice.
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Affiliation(s)
- Lara M Genik
- Lara M. Genik, Elisabeth L. Aerts, and Hiba Nauman, University of Guelph, Ontario, Canada
| | - Elisabeth L Aerts
- Lara M. Genik, Elisabeth L. Aerts, and Hiba Nauman, University of Guelph, Ontario, Canada
| | - Hiba Nauman
- Lara M. Genik, Elisabeth L. Aerts, and Hiba Nauman, University of Guelph, Ontario, Canada
| | | | - Stephen P Lewis
- Stephen P. Lewis and C. Meghan McMurtry, University of Guelph, Ontario, Canada
| | - C Meghan McMurtry
- Lara M. Genik, Elisabeth L. Aerts, and Hiba Nauman, University of Guelph, Ontario, Canada
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Genik LM, Aerts EL, Barata PC, Barney CC, Lewis SP, Newby-Clark I, McMurtry CM. A Randomized Controlled Trial Evaluating a Pain Assessment and Management Program for Respite Workers Supporting Children With Disabilities Part One: Pain-Related Knowledge and Perceptions. Am J Intellect Dev Disabil 2021; 126:271-288. [PMID: 34161565 DOI: 10.1352/1944-7558-126.4.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/13/2021] [Indexed: 06/13/2023]
Abstract
This parallel group randomized controlled trial tested effectiveness of the Let's Talk About Pain training on respite workers' (RW) pain-related knowledge and feasibility-confidence-skill ratings using between-group and within-group analyses. Fourteen children's respite organizations were randomized to pain or control training. Participants (nintervention = 66; ncontrol = 92) underwent a 3-3.5 hour training and completed measures at pre-, post-, and 4-6 week follow-up. Intention-to-treat (nintervention = 65; ncontrol = 92) and per-protocol (nintervention = 26-38; ncontrol = 40-57) analyses were conducted. Pain training participants demonstrated significantly higher pain knowledge and feasibility-confidence-skill ratings post-follow-up versus control group and significant increases in knowledge from pre-post. Significant gains were maintained from post-follow-up. Results represent a promising step towards enhancing pain-related care for children with IDD.
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Affiliation(s)
- Lara M Genik
- Lara M. Genik, Elisabeth L. Aerts, and Paula C. Barata, University of Guelph, Ontario, Canada
| | - Elisabeth L Aerts
- Lara M. Genik, Elisabeth L. Aerts, and Paula C. Barata, University of Guelph, Ontario, Canada
| | - Paula C Barata
- Lara M. Genik, Elisabeth L. Aerts, and Paula C. Barata, University of Guelph, Ontario, Canada
| | | | - Stephen P Lewis
- Stephen P. Lewis, Ian Newby-Clark, and C. Meghan McMurtry, University of Guelph, Ontario, Canada
| | - Ian Newby-Clark
- Stephen P. Lewis, Ian Newby-Clark, and C. Meghan McMurtry, University of Guelph, Ontario, Canada
| | - C Meghan McMurtry
- Lara M. Genik, Elisabeth L. Aerts, and Paula C. Barata, University of Guelph, Ontario, Canada
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Lee S, Edwards K, McMurtry CM. A cognitive-behavioral group intervention for parents of youth with chronic pain: Development, feasibility, and preliminary effectiveness. Clinical Practice in Pediatric Psychology 2021. [DOI: 10.1037/cpp0000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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MacKenzie NE, Tutelman PR, Chambers CT, Parker JA, MacDonald NE, McMurtry CM, Pluye P, Granikov V, Taddio A, Barwick M, Birnie KA, Boerner KE. Factors associated with parents' experiences using a knowledge translation tool for vaccination pain management: a qualitative study. BMC Health Serv Res 2021; 21:355. [PMID: 33863339 PMCID: PMC8052692 DOI: 10.1186/s12913-021-06326-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool. Methods A qualitative descriptive design was used. A total of 20 parents of children aged 0–17 years (n = 19 mothers) reviewed the KT tool ahead of their child’s upcoming vaccination and participated in a semi-structured interview at follow-up. Interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis using an inductive approach. Results The analysis generated three interrelated themes which described factors related to parents’ use of the KT tool: (1) Relevance to parents’ needs and circumstances surrounding their child’s vaccination; (2) Alignment with parents’ personal values around, and experiences with, vaccination pain management (e.g., the importance of managing pain); and (3) Support from the clinical environment for implementing evidence-based strategies (e.g., physical clinical environment and quality of interactions with the health care provider). Conclusions Several factors were identified as central to parents’ use of the KT tool, including the information itself and the clinical environment. When the tool was perceived as relevant, aligned with parents’ values, and was supported by health care providers, parents were more inclined to use the KT tool to manage their children’s vaccination pain. Future research could explore other factors related to promoting engagement and uptake when creating parent-directed KT tools for a range of health-related contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06326-2.
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Affiliation(s)
- Nicole E MacKenzie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada. .,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada. .,Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada.
| | - Jennifer A Parker
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada
| | - C Meghan McMurtry
- University of Guelph, Department of Psychology, Guelph, Ontario, Canada and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Pierre Pluye
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Vera Granikov
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Anna Taddio
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,8University of Toronto, Department of Psychiatry, Faculty of Medicine and University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,University of Calgary, Department of Anesthesiology, Perioperative and Pain Medicine, Calgary, Alberta, Canada
| | - Katelynn E Boerner
- BC Children's Hospital & University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
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Abstract
Abstract. Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.
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Affiliation(s)
| | | | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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MacKenzie NE, Tutelman PR, Chambers CT, Parker JA, MacDonald NE, McMurtry CM, Pluye P, Granikov V, Taddio A, Barwick M, Birnie KA, Boerner KE. Understanding parents' use of a knowledge translation tool to manage children's vaccination pain. Pain Rep 2021; 6:e907. [PMID: 33728388 PMCID: PMC7954376 DOI: 10.1097/pr9.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 01/12/2023] Open
Abstract
Supplemental Digital Content is Available in the Text. The relevance of KT tools, and parents' confidence in using them, was related to uptake of vaccination pain management strategies for children. Introduction: Although several evidence-based strategies for managing children's vaccination pain exist, many parents report being unaware of them. Knowledge translation (KT) tools present evidence-based information in plain language. Objectives: This two-phase study assessed parents/caregivers' uptake of evidence-based pain management strategies via a KT tool and considered factors related to parents' planned, actual, and future use of these strategies. Methods: In phase 1, parents were exposed to an online KT tool on physical, psychological, and pharmacological vaccination pain management strategies, and their impressions were assessed by questionnaires including the Information Assessment Method for Parents. In phase 2, after vaccination, parents completed a follow-up survey on their uptake and experiences using the information. Results: A total of 312 participants reported their plans for KT tool use. Parents who found the KT tool relevant were more likely to plan to use it at their child's upcoming vaccination. A total of 128 parents (93% mothers) completed both surveys. Nearly all parents who planned to use the information did so during their child's subsequent vaccination (90%). When the KT tool was relevant to their needs, parents were more likely to use the information during their child's vaccination. Parents who felt confident using the tool were significantly more likely to report plans for future tool use. Discussion: This study demonstrates the effectiveness of a KT tool that was relevant to parents' needs and built confidence to increase parent-reported uptake of evidence-based strategies. Proper pain management could positively impact parents' uptake of vaccinations for children.
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Affiliation(s)
- Nicole E MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada, and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Vera Granikov
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Department of Psychiatry, Faculty of Medicine, University of Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada
| | - Katelynn E Boerner
- Department of Psychiatry, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Genik LM, McMurtry CM, Barata PC, Barney CC, Lewis SP. The importance of feasible outcome evaluations: Developing stakeholder‐informed outcomes in a randomized controlled trial for children’s respite workers receiving pain training. Paediatric and Neo Pain 2021; 3:12-19. [PMID: 35548847 PMCID: PMC8975221 DOI: 10.1002/pne2.12026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 11/05/2022]
Abstract
Objective Pain is common for children with intellectual and developmental disabilities. It is critical that caregivers have adequate pain assessment and management knowledge. The Let’s Talk About Pain program has shown promise to provide pain‐related knowledge and skills to respite workers; however, more systematic evaluation of the program is needed. This study aims to support Let’s Talk About Pain’s RCT development by using stakeholder input to help determine a feasible approach for collecting behaviorally based outcomes. A secondary aim is to discuss relevant considerations and implications for others in the disability field conducting similar work. Methods/Design Four employees in children’s respite organizations completed telephone interviews lasting approximately fifteen minutes and a questionnaire about feasible data collection approaches. Results The use of questionnaire and focus group methodology was determined to be the most feasible method to evaluate participants’ pain‐related approaches in practice. Conclusions Special consideration should be made when making methodological‐related choices during study development to help ensure study feasibility. The iterative approach described in this paper may also be helpful in clinical settings when designing program evaluations to enhance feasibility and suitability; it is particularly important for multifaceted organizations supporting individuals with complex needs including those with intellectual and developmental disabilities.
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Affiliation(s)
- Lara M. Genik
- Department of Psychology University of Guelph Guelph ON Canada
| | - C. Meghan McMurtry
- Department of Psychology University of Guelph Guelph ON Canada
- Pediatric Chronic Pain Program McMaster Children’s Hospital Hamilton ON Canada
- Department of Pediatrics Children’s Health Research Institute Western University London ON Canada
| | - Paula C. Barata
- Department of Psychology University of Guelph Guelph ON Canada
| | - Chantel C. Barney
- Gillette Children’s Specialty Health Care University of Minnesota Minneapolis MinnesotaUSA
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Jones A, Caes L, McMurtry CM, Eccleston C, Jordan A. Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review. J Pediatr Psychol 2021; 46:219-230. [PMID: 33211876 DOI: 10.1093/jpepsy/jsaa101] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/21/2020] [Accepted: 10/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10-24 years with chronic pain. METHODS A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized. RESULTS Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored. CONCLUSIONS Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social-developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs.
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Affiliation(s)
- Abigail Jones
- Department of Psychology, University of Bath.,Centre for Pain Research, University of Bath
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph.,Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath.,Department of Health, University of Bath
| | - Abbie Jordan
- Department of Psychology, University of Bath.,Centre for Pain Research, University of Bath
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Taddio A, Coldham J, Logeman C, McMurtry CM, Little C, Samborn T, Bucci LM, MacDonald NE, Shah V, Dribnenki C, Snider J, Stephens D. Feasibility of implementation of CARD™ for school-based immunizations in Calgary, Alberta: a cluster trial. BMC Public Health 2021; 21:260. [PMID: 33526030 PMCID: PMC7849968 DOI: 10.1186/s12889-021-10247-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/14/2021] [Indexed: 01/23/2023] Open
Abstract
Background Negative experiences with school-based immunizations can contribute to vaccine hesitancy in youth and adulthood. We developed an evidence-based, multifaceted and customizable intervention to improve the immunization experience at school called the CARD™ (C-Comfort, A-Ask, R-Relax, D-Distract) system. We evaluated the feasibility of CARD™ implementation for school-based immunizations in Calgary, Canada. Methods In a mixed methods study, two Community Health Centres providing immunization services, including 5 schools each with grade 9 students (aged approximately 14 years), were randomized to CARD™ or control (usual care). In the CARD™ group, public health staff and students were educated about coping strategies prior to immunization clinics. Clinics were organized to reduce fear and to support student’s choices for coping strategies. Public health staff in the CARD™ group participated in a focus group discussion afterwards. We sought a recruitment rate of 80% for eligible schools, an external stakeholder focus group (e.g., school staff) with 6 or more individuals, 85% of individual injection-related data acquisition (student and immunizer surveys), and 80% absolute agreement between raters for a subset of data that were double-coded. Across focus groups, we examined perceptions of acceptability, appropriateness, feasibility and fidelity of CARD™. Results Nine (90%) of eligible schools participated. Of 219 students immunized, injection-related student and immunizer data forms were acquired for 195 (89.0%) and 196 (89.5%), respectively. Reliability of data collection was high. Fifteen public health and 5 school staff participated in separate focus groups. Overall, attitudes towards CARD™ were positive and compliance with individual components of CARD™ was high. Public health staff expressed skepticism regarding the value of student participation in the CARD™ system. Suggestions were made regarding processes to refine implementation. Conclusion While most outcome criteria were satisfied and overall perceptions of implementation outcomes were positive, some important challenges and opportunities were identified. Feedback is being used to inform a large cluster trial that will evaluate the impact of CARD™ during school-based immunizations. Trial registration The trial is registered at ClinicalTrials.gov (NCT03948633); Submitted April 24, 2019.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada.
| | - Joanne Coldham
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Charlotte Logeman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, 4003 Mackinnon Building (Mackinnon Extension), Guelph, Ontario, N1G 2W1, Canada
| | - Cheri Little
- Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada
| | - Tracy Samborn
- Cochrane Community Health Centre, Alberta Health Services, 60 Grande Blvd, Cochrane, Alberta, T4C 0S4, Canada
| | - Lucie M Bucci
- Immunize Canada, 404-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Noni E MacDonald
- IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada
| | - Cindy Dribnenki
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Joanne Snider
- Alberta Health Services, Suite 104 Main Floor West Tower, 14310-111 Avenue, Edmonton, Alberta, T5M 3Z7, Canada
| | - Derek Stephens
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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Dalley JS, Morrongiello BA, McMurtry CM. Children's Perspectives on Outpatient Physician Visits: Capturing a Missing Voice in Patient-Centered Care. Children (Basel) 2021; 8:34. [PMID: 33430441 PMCID: PMC7827829 DOI: 10.3390/children8010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
Actively involving children in their healthcare is a core value of patient-centered care. This is the first study to directly obtain children's detailed perspectives on positive and negative aspects of outpatient physician visits in a primary care setting (e.g., checkups) and their preferred level of participation. Individual interviews were conducted with 167 children (female n = 82, male n = 85; ages 7-10, Mage = 8.07 years, SD = 0.82). Open-ended questions were used so that children's responses were not confined to researchers' assumptions, followed by close-ended questions to meet specific objectives. Quantitative content analysis, correlations, logistic regression, and Cochran's Q were used to explore the data. Children were highly fearful of needle procedures (61%), blood draws (73%), pain (45%), and the unknown (21%). Children indicated that they liked receiving rewards (32%) and improving their health (16%). Children who were more fearful during physician visits wanted more preparatory information (ExpB = 1.05, Waldx2(1) = 9.11, p = 0.003, McFadden's R2 2 = 0.07) and more participation during the visit (ExpB = 1.04, Waldx2(1) = 5.88, p = 0.015, McFadden's R2 2 = 0.03). Our results can inform efforts to promote positive physician visit experiences for children, reduce procedural distress, and foster children's ability to take an active role in managing their health.
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Affiliation(s)
- Jessica S. Dalley
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.S.D.); (B.A.M.)
| | - Barbara A. Morrongiello
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.S.D.); (B.A.M.)
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.S.D.); (B.A.M.)
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
- Department of Paediatrics, Western University, London, ON N6A 3K7, Canada
- Children’s Health Research Institute, London, ON N6C 2V5, Canada
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MacDonald NE, Comeau J, Dubé È, Graham J, Greenwood M, Harmon S, McElhaney J, Meghan McMurtry C, Middleton A, Steenbeek A, Taddio A. Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies. Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.
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Affiliation(s)
- Noni E. MacDonald
- Department of Pediatrics (Infectious Diseases), Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Jeannette Comeau
- Division of Infectious Diseases, Dalhousie University and IWK Health Centre, Halifax, Canada
| | - Ève Dubé
- Scientific Group on Immunization at the Quebec National Institute of Public Health, Québec, Canada
- Department of Anthropology, Université Laval, Québec, QC G1V 0A6, Canada
| | - Janice Graham
- Department of Pediatrics, Division of Infectious Diseases, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Margo Greenwood
- School of Education, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- Department of First Nations Studies, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada
- National Collaborating Centre for Indigenous Health, Prince George, BC V2N 4Z9, Canada
| | - Shawn Harmon
- Department of Pediatrics, Technoscience and Regulation Research Unit, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
- Health Sciences North Research Institute, Sudbury, ON P3E 2H2, Canada
| | - C. Meghan McMurtry
- Pediatric Pain, Health and Communication Lab (PPHC), University of Guelph, Guelph, ON N1G 2W1, Canada
- Department of Psychology, University of Guelph, Guelph, ON N1G 2W1, Canada
- Clinical and Health Psychologist with the Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Alan Middleton
- Schulich Executive Education Centre, York University, North York, ON M3J 1P3, Canada
| | - Audrey Steenbeek
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Taddio A, Bucci L, McMurtry CM, MacDonald N, Badali M. Introducing a practical tool to reduce fear and anxiety during COVID-19. Can Pharm J (Ott) 2020; 154:26-29. [PMID: 33598056 DOI: 10.1177/1715163520975424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa
| | | | - Noni MacDonald
- the Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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Genik LM, Millett GE, McMurtry CM. Facilitating respite, communication, and care for children with intellectual and developmental disabilities: Preliminary evaluation of the Caregiver Pain Information Guide. Clinical Practice in Pediatric Psychology 2020. [DOI: 10.1037/cpp0000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Logeman C, Taddio A, McMurtry CM, Bucci L, MacDonald N, Chalmers G, Gudzak V, Shah V, Coldham J, Little C, Samborn T, Dribnenki C, Snider J. Student Feedback to Tailor the CARD™ System for Improving the Immunization Experience at School. Children (Basel) 2020; 7:E126. [PMID: 32899632 PMCID: PMC7552616 DOI: 10.3390/children7090126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
Increasing the comfort of vaccine delivery at school is needed to improve the immunization experience for students. We created the CARD™ (C-Comfort, A-Ask, R-Relax and D-Distract) system to address this clinical care gap. Originally designed for grade 7 students, this study examined the perceptions of grade 9 students of CARD™. Grade 9 students who had experience with school-based immunizations, either as recipients or onlookers (n = 7; 100% females 14 years old) participated. Students answered pre-post surveys, reviewed CARD™ educational materials and participated in a semi-structured focus group discussion. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis of qualitative data. Participants reported positive perceptions of CARD™ educational materials and that CARD™ could fit into the school immunization process. CARD™ improved knowledge about effective coping interventions and was recommended for education of both nurses and students. The results provide preliminary evidence that CARD™ is acceptable and appropriate for implementation in grade 9 school-based immunizations.
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Affiliation(s)
- Charlotte Logeman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - C. Meghan McMurtry
- Department of Psychology, The University of Guelph, Guelph, ON N1G 2W1, Canada;
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, ON K1Z 8R9, Canada;
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada;
| | - Garth Chalmers
- University of Toronto Schools, Toronto, ON M5S 2R7, Canada;
| | - Victoria Gudzak
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada; (C.L.); (V.G.)
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada;
| | - Joanne Coldham
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cheri Little
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Tracy Samborn
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Cindy Dribnenki
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
| | - Joanne Snider
- Alberta Health Services, Calgary, AB T2W 3N2, Canada; (J.C.); (C.L.); (T.S.); (C.D.); (J.S.)
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41
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Moline RL, Chambers C, McMurtry CM. Study protocol for a randomized controlled trial of a child and parent mindfulness intervention for pediatric venipuncture. Paediatr Neonatal Pain 2020; 3:20-28. [PMID: 35548848 PMCID: PMC8975227 DOI: 10.1002/pne2.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
Children commonly undergo painful needle procedures. Unmanaged procedural pain can have short‐ and long‐term consequences, including longer procedure times, greater distress at future procedures, and vaccine hesitancy. While parent behaviors are one of the strongest predictors of children's response to acute pain, pediatric procedural pain management interventions focus almost exclusively on the child. Further, existing parent‐involved pediatric pain management interventions typically fail to improve child self‐reported pain during painful procedures. The current protocol offers the first randomized controlled trial involving a mindfulness intervention for pediatric acute pain that includes children and their parents. This study aims to conduct a single‐site, two‐arm, parallel‐group RCT to examine the effects of a mindfulness intervention for parents and children before child venipuncture compared to a control group on primary (child self‐report of pain and fear), secondary (parent self‐report and child report of parent distress), and tertiary outcomes (parent report of child pain and fear). Parent‐child dyads (n = 150) will be recruited from the McMaster Children's Hospital outpatient blood laboratory. Dyads will be randomly assigned to either a mindfulness group guided through a mindfulness intervention or control group guided through an unfocused attention task. Parents will accompany their child for their venipuncture. Postvenipuncture measures will be collected (eg, child pain‐related outcomes as reported by parents and children). The first enrollment occurred in October 2019. We offer a novel intervention that aims to facilitate both parent and child coping during child venipuncture. The current protocol offers the first randomized controlled trial involving a mindfulness intervention for pediatric acute pain that includes children and their parents. This study aims to conduct a single‐site, two‐arm, parallel‐group RCT to examine the effects of a mindfulness intervention for parents and children (aged 7‐12) before child venipuncture compared to a control group on primary (child self‐report of pain and fear), secondary (parent self‐report and child report of parent distress), and tertiary outcomes (parent report of child pain and fear). We offer a novel intervention that aims to facilitate both parent and child coping during child venipuncture.
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Affiliation(s)
- Rachel L Moline
- Department of Psychology University of Guelph Guelph ON Canada
| | - Christine Chambers
- Department of Psychology and Neuroscience Dalhousie University Halifax NS Canada.,Department of Pediatrics Dalhousie University Halifax NS Canada.,Centre for Pediatric Pain Research IWK Health Centre Halifax NS Canada
| | - C Meghan McMurtry
- Department of Psychology University of Guelph Guelph ON Canada.,Pediatric Chronic Pain Program McMaster Children's Hospital Hamilton ON Canada.,Department of Paediatrics Schulich School of Medicine & Dentistry Western University London ON Canada
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McMurtry CM. Managing immunization stress-related response: A contributor to sustaining trust in vaccines. Can Commun Dis Rep 2020; 46:210-218. [PMID: 32673376 DOI: 10.4745/ccdr.v46i06a10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adverse events following immunizations (AEFI) are important to identify and manage effectively so as to sustain trust in vaccines and optimize health. The AEFI category related to "anxiety about the immunization" was considered problematic as it did not adequately capture the range of stress responses that can occur. The currently used term for this category, immunization stress-related responses (ISRR), is broader, including the full spectrum of signs and symptoms that can arise in response to stress. ISRR can include vasovagal reactions (fainting), hyperventilation and functional neurological symptoms (e.g. weakness, nonepileptic seizures). It is based on a biopsychosocial framework in which biological (e.g. age, sex), psychological (e.g. preparedness, previous experiences, anxiety) and social factors (e.g. response by others, social media) interact to create an individual's stress response to the immunization process. New guidance is available on prevention, early detection and management of ISRRs which is summarized in the article.
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Affiliation(s)
- C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON.,Pediatric Chronic Pain Program, McMaster University, Hamilton, ON.,Adjunct Research Professor, Department of Paediatrics, Western University, London, ON.,Associate Scientist, Children's Health Research Institute, London, ON
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43
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Moline RL, Constantin KL, Gauthier MN, Powell DM, McMurtry CM. SUPER scale to the rescue: reconciling what parents say and what they communicate during their child's pain. Pain Manag 2020; 10:179-194. [PMID: 32362183 DOI: 10.2217/pmt-2019-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Fully illuminating mechanisms relating parent behaviors to child pain require examining both verbal and nonverbal communication. We conducted a multimethod investigation into parent nonverbal communication and physiology, and investigated the psychometric properties of the Scheme for Understanding Parent Emotive Responses Scale to assess parent nonverbals accompanying reassurance and distraction. Materials & methods: 23 children (7-12 years of age) completed the cold pressor task with their parent (predominately mothers). Parent heart rate and heart rate variability were monitored and assessed. The Scheme for Understanding Parent Emotive Responses Scale coding of parent nonverbal behaviors (i.e., vocal cues, facial expressions, posture) was used to detect levels of fear, warmth, disengagement and humor. Results & conclusion: Preliminary evidence for the psychometric properties of the scale are offered. Parent reassurance was associated with more fear, less warmth and less humor compared with distraction.
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Affiliation(s)
- Rachel L Moline
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | | | - Megan N Gauthier
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Deborah M Powell
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.,Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, L8N 3Z5, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A 5C1, Canada
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Gold MS, MacDonald NE, McMurtry CM, Balakrishnan MR, Heininger U, Menning L, Benes O, Pless R, Zuber PLF. Immunization stress-related response - Redefining immunization anxiety-related reaction as an adverse event following immunization. Vaccine 2020; 38:3015-3020. [PMID: 32131975 DOI: 10.1016/j.vaccine.2020.02.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022]
Abstract
The Council for the International Organizations of Medical Sciences (CIOMS) and WHO working group on pharmacovigilance defines five cause specific AEFI which includes an immunization anxiety-related reaction. Historically this term has been used to describe a range of symptoms and signs that may arise after immunization that are related to "anxiety" about the immunization. However, the term "anxiety" does not adequately capture all the elements of this cause specific AEFI. In 2015, the Global Advisory Committee for Vaccine Safety convened an expert working group with the purpose of redefining, preventing and managing this particular AEFI. The term "Immunization Stress-Related Response" is proposed to replace the former terminology. We present a manual that redefines this AEFI and present a framework for prevention, diagnosis and management in both an individual and also when such events occur as clusters and affect multiple individuals. Since such mass events can result in cessation of immunization programmes and/or a loss of public confidence, a communication response is essential.
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Affiliation(s)
- Michael S Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Australia.
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Madhava Ram Balakrishnan
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
| | - Ulrich Heininger
- Division of Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Lisa Menning
- Expanded Programme on Immunization, World Health Organisation, Geneva, Switzerland
| | - Oleg Benes
- Regional Office Europe, World Health Organisation, Denmark
| | - Robert Pless
- Clinical Evaluation Division, Vaccines/Blood Biologics and Genetic Therapies Directorate, Health Canada, Canada
| | - Patrick L F Zuber
- Department of Essential Medicines and Health Products (EMP), World Health Organization, Genève, Switzerland
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Genik LM, McMurtry CM, Barata PC, Barney CC, Lewis SP. Study protocol for a multi‐centre parallel two‐group randomized controlled trial evaluating the effectiveness and impact of a pain assessment and management program for respite workers supporting children with disabilities. Paediatric and Neo Pain 2020; 2:7-13. [PMID: 35547857 PMCID: PMC8975185 DOI: 10.1002/pne2.12014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Lara M. Genik
- Department of Psychology University of Guelph Guelph ON Canada
| | - C. Meghan McMurtry
- Department of Psychology University of Guelph Guelph ON Canada
- Pediatric Chronic Pain Program McMaster Children’s Hospital Hamilton ON Canada
- Children’s Health Research Institute London Canada
- Department of Pediatrics Western University London ON Canada
| | - Paula C. Barata
- Department of Psychology University of Guelph Guelph ON Canada
| | - Chantel C. Barney
- Gillette Children’s Specialty Health Care Department of Educational Psychology University of Minnesota Minneapolis MN USA
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Genik LM, McMurtry CM, Marshall S, Rapoport A, Stinson J. Massage therapy for symptom reduction and improved quality of life in children with cancer in palliative care: A pilot study. Complement Ther Med 2019; 48:102263. [PMID: 31987232 DOI: 10.1016/j.ctim.2019.102263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND For children with cancer in palliative care, pain and worry are common and frequently under-managed, which negatively impacts quality of life (QOL). Massage therapy (MT) can lead to reduced pain in children with chronic illnesses. Children with cancer have experienced lower anxiety after MT. No studies have examined the effects of MT in pediatric oncology patients receiving palliative care. OBJECTIVE Conduct a MT intervention to determine intervention acceptability and initial effects on ratings of pain, worry reduction, and quality of life. DESIGN Pre-post single group pilot study. SETTING/SUBJECTS Eight children with cancer (age 10-17) and one of their parents were recruited from a palliative care service. PROCEDURE/MEASUREMENTS Baseline (one week prior to intervention): demographics, MT expectations, QOL, and pain measures. Intervention (one month): MT was provided once per week, with children's pain and worry ratings occurring immediately before and after each MT session. Follow Up (4-6 weeks after baseline): QOL, pain, and MT/study acceptability questionnaires. RESULTS Participants reported significant decreases in pain following two MT sessions, and worry following one session. No significant changes in pain symptoms and QOL were found between baseline and follow up. Participants positively endorsed the study and the MT intervention, and there were no adverse effects reported. CONCLUSIONS MT may lead to immediate decreases in pain and worry in children with cancer who are receiving palliative care, however the effects may not be sustained long term. Difficulties regarding protocol feasibility including recruitment and study compliance remain important considerations for future work.
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Affiliation(s)
- Lara M Genik
- Department of Psychology, University of Guelph, Canada.
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Clinical and Health Psychologist, Pediatric Chronic Pain Program, McMaster Children's Hospital, Associate Scientist, Children's Health Research Institute, Adjunct Researcher, Department of Pediatrics, Western University, Canada.
| | | | - Adam Rapoport
- The Hospital for Sick Children, Emily's House Children's Hospice, Canada.
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Freedman T, Taddio A, Alderman L, McDowall T, deVlaming-Kot C, McMurtry CM, MacDonald N, Alfieri-Maiolo A, Stephens D, Wong H, Boon H. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on student symptoms. Paediatr Child Health 2019; 24:S42-S53. [PMID: 30948922 PMCID: PMC6438866 DOI: 10.1093/pch/pxz020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many students are afraid of receiving vaccinations at school. We implemented a novel, multifaceted knowledge translation intervention incorporating evidence-based vaccination coping strategies-The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-and evaluated impact on student attitudes, knowledge, coping strategies used, and symptoms during school-based vaccinations. METHODS Mixed methods. Ten schools participated in a controlled clinical trial: five experimental and five control. Experimental School (ES) students completed a knowledge and attitudes survey during an in-class CARD™ educational session prior to school vaccinations and selected coping strategies for upcoming vaccinations. Control School (CS) students received the usual vaccine education lesson, which did not include information about or selection of coping strategies. At all schools and during both vaccination clinic visits (fall and spring), injecting nurses recorded specific coping strategies used, and students independently rated their fear, pain, and dizziness during vaccinations. Focus groups were conducted at five schools after all clinics were completed (three ES, two CS). RESULTS ES students had higher knowledge (P<0.001), less fear (P=0.03), and greater willingness to be vaccinated (P=0.001) after the in-class education session. Students rated the education as understandable, sufficient, useful, and that it prepared them for vaccinations. During school vaccination clinics, ES students selected more coping interventions than CS students. There were fewer students with high levels of fear (P=0.008) and dizziness (P=0.04) in the ES group. In round 2, fewer students (P=0.02) in the ES group returned to the clinic postvaccination because they were feeling unwell. ES students participating in focus groups scored higher on their knowledge test (P<0.001) compared with CS students and reported learning and benefitting from CARD™. DISCUSSION This small-scale implementation study provides preliminary evidence of the effectiveness of CARD™ in improving vaccination experiences for students at school. Future research is recommended that examines CARD™ in different settings to confirm these results.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | | | | | | | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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Taddio A, Alderman L, Freedman T, McDowall T, McMurtry CM, MacDonald N, deVlaming-Kot C, Alfieri-Maiolo A. The CARD™ System for improving the vaccination experience at school: Results of a small-scale implementation project on program delivery. Paediatr Child Health 2019; 24:S54-S67. [PMID: 30948923 PMCID: PMC6438865 DOI: 10.1093/pch/pxz021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We conducted a small-scale implementation study that integrated The CARD™ System (C-Comfort, A-Ask, R-Relax, D-Distract)-a multifaceted knowledge translation intervention designed to improve the vaccination experience at school-within the school vaccination program. METHODS Mixed methods design, including a controlled clinical trial and focus group interviews. The experimental group included five schools whereby CARD™ was implemented. The control group included five schools whereby no changes were made. Focus groups were held at the end of the school year. For nurses trained in CARD™, additional focus groups were held at CARD™ training and after the first round of vaccine clinic visits. Outcomes included vaccination rate at school and adult stakeholder perceptions. RESULTS Altogether, 323 students attended study schools. Fifty-five nurses, school staff, and parents participated in 15 focus groups. The school vaccination rate did not differ (P>0.05) between groups for round 1 clinics (76% versus 77%) or round 2 clinics (68% versus 70%). Participants reported acceptability, appropriateness, feasibility, and satisfaction with CARD™. Experimental group nurses were able to integrate CARD™ within usual activities, including clinic planning, student education, and clinic-day set-up and student vaccinations. Students in experimental schools were described by nurses and school staff as more prepared and less fearful during vaccinations. Nurses reported that CARD™ built on their practice; they had higher confidence in their ability to assess pain and fear and higher satisfaction with their ability to manage it. Nurses also reported improved collaboration with students and with each other. All stakeholder groups recommended continuing CARD™. Some additional time was required, primarily related to clinic planning activities and data collection for study purposes. CONCLUSION CARD™ is a promising new approach for improving the delivery of vaccinations at school. Exploration of approaches to increase parental reach and monitoring of vaccination uptake rate over time are recommended.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Taddio A, Freedman T, Wong H, McMurtry CM, MacDonald N, Ilersich ANT, Ilersich ALT, McDowall T. Stakeholder feedback on The CARD™ System to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S29-S34. [PMID: 30948920 PMCID: PMC6438868 DOI: 10.1093/pch/pxz018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE School-based vaccination programs can be a source of distress for many students due to the pain from the needle injection and related fears. We created a multifaceted Knowledge Translation (KT) intervention to address vaccination and pain, fear, and fainting called The CARD™ System. The objectives were to document acceptability of key tools included in the multifaceted KT intervention and their effectiveness in improving knowledge and attitudes about vaccination pain and fear. METHODS Quantitative and qualitative methods were used. Students, school staff, public health nurses, and parents participated in separate focus groups whereby they independently completed a knowledge and attitudes survey and provided structured and qualitative feedback on key KT tools of the multifaceted KT intervention. They then repeated the knowledge and attitudes survey. RESULTS Altogether, 22 students (grade 6 and 7), 16 school staff (principals, grade 7 and 8 teachers, resource teachers, secretaries), 10 nurses (injecting, charge, and school nurses), and 3 parents participated. Knowledge test scores increased post-KT tool review: 8.5 (2.1) versus 7.3 (1.9); P<0.001. Attitudes were more positive about the individual nature of pain and fear experience during vaccination. Student fear scores were lower post-tool review: 5.1 (2.9) versus 4.6 (3.0); P<0.001. The majority of the participants reported they understood all the information, the amount was just right and that the information was useful. DISCUSSION The KT tools were demonstrated to be acceptable and to improve knowledge. Future research is warranted to determine their impact on student experience during school vaccinations.
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Affiliation(s)
- Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- The Hospital for Sick Children, Toronto, Ontario
| | - Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | | | | | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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Freedman T, Taddio A, McMurtry CM, Wong H, MacDonald N, McDowall T, deVlaming-Kot C, Alderman L. Involving stakeholders in informing the development of a Knowledge Translation (KT) intervention to improve the vaccination experience at school. Paediatr Child Health 2019; 24:S19-S28. [PMID: 30948919 PMCID: PMC6438867 DOI: 10.1093/pch/pxz017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/28/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Pain, fear, and fainting management during school-based vaccinations is suboptimal. The objective was to examine stakeholder perceptions of barriers and facilitators to better practices. Method: Six semi-structured focus groups were conducted in Niagara Region, Ontario: two parent groups (n=7); one grade 7 to 8 student group (n=9); two nurse groups (n=12); and one school staff group (n=6). Participants shared perceptions about school vaccination clinics and the implementation of specific strategies and tools. Focus groups were audio recorded and transcribed. The Consolidated Framework for Implementation Research (CFIR) was used as the framework for analysis. RESULTS Feedback from stakeholders was categorized into four domains of CFIR: intervention characteristics, inner setting, outer setting, and characteristics of individuals. Intervention characteristics included: vaccine educational materials, vaccination accommodations, distraction techniques, topical anaesthetics, and food. Inner setting factors included: school vaccination procedures, relationships between school staff and nurses, assessment and documentation of student fear, and factors that contribute to a chaotic vaccination clinic. Outer setting factors were: the social environment and addressing parent and student needs. Stakeholder roles were discussed in characteristics of individuals. CONCLUSION This study identified elements that can facilitate and challenge pain and fear mitigation tools and strategies; these elements should be considered in the development of a Knowledge Translation (KT) intervention to improve the school vaccination experience.
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Affiliation(s)
- Tamlyn Freedman
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Horace Wong
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
| | | | - Tori McDowall
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
| | | | - Leslie Alderman
- Niagara Region Public Health & Emergency Services, Thorold, Ontario
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