Perceptions of children and their parents about the pain experienced during their hospitalization and its impact on parents’ quality of life

Derry

et al. 2018

Pain

Pain assessment by patients is the rule in clinical trials but may not be in clinical practice. We examined studies comparing assessment of pain by patients and professionals in clinical practice using published studies (1990-2016; ≥20 patients), in English, in an institutional setting, comparing pain assessment within 24 hours by patients and health care professionals. A difference of at least 10% of the maximum score was considered significant. We judged quality on sampling method, blinding, and study size. Eighty studies (20,496 patients) provided data from a range of settings and locations; most (51%) used unbiased sampling, and most (68%) were blind or probably blind. Nine studies with ≥500 patients involved 58% of patients; 60 with <200 patients involved 25%. Large studies were more likely to use comprehensive or random sampling and blinding of patients and professionals. Underestimation of pain by professionals compared with patients was reported by 62/80 studies (78%); there was no difference in 17 (21%) and overestimation in 1 (1%). Underestimation was reported in 75% of large studies (>500 patients), 91% of mid-sized studies (200-400), and 78% of small studies (<200). High-quality studies (blind, comprehensive, or random sampling, >200 patients) consistently reported underestimation (10/11; 91%). The extent of underestimation tended to increase with pain severity. Professionals consistently tend to underestimate pain compared with assessment by patients. This tendency is more pronounced with more severe pain, and the extent of underestimation can be large. It is likely that this contributes to undertreatment of pain.

Section: Discussionmentioning

confidence: 99%

Professionals underestimate patients' pain: a comprehensive review

Derry

et al. 2018

Pain

“…Três domínios sobressaíram-se nos resultados: Dor (mães subestimam as dores vivenciadas pelos filhos), Ansiedade frente aos procedimentos (mães superestimam as dificuldades dos filhos frente à necessidade de exames) e Comunicação (domínio no qual se obteve maior aproximação entre as respostas dos dois grupos). A tendência a perceber como menor a intensidade da dor vivenciada pelos filhos foi encontrada em outro estudo 21 , que investigou 251 crianças (92 com câncer) e seus pais, com o mesmo instrumento utilizado no presente estudo.…”

Section: Discussionunclassified

“…A avaliação da dor é subjetiva e pode afetar diferentes esferas da QV do paciente, e que a mãe, em especial, é peça importante no manejo desse sintoma, sendo, portanto, de fundamental importância que ela compreenda a real dimensão com que a criança vivencia sua experiência álgica 21 .…”

Section: Discussionunclassified

See 1 more Smart Citation

Qualidade de vida pós-transplante de medula óssea: comparação entre avaliação das crianças e das mães

Cardoso

Garcia²,

Guimarães

et al. 2018

REFACS

Este estudo teve por objetivo avaliar a qualidade de vida de crianças submetidas ao transplante de medula óssea e comparar os resultados da autoavaliação com o heteroavaliação realizada pelas mães. A amostra foi composta por 14 participantes, sete mães e seus respectivos filhos. Utilizou-se o Questionário Pediátrico de Qualidade de Vida PedsQL™. Os resultados indicam diferença significativa nos valores da avaliação das mães e crianças, sendo que mães superestimaram a QV dos filhos. Este indicador é importante porque sugere necessidade de implementar intervenções com as díades, visando facilitar o diálogo e ampliar a compreensão das vivências emocionais das crianças pelas mães.

J Paediatrics Child Health

“…demonstrated that parents are able to offer reasonable estimates of their child's pain. However, parents may tend to overestimate symptoms in acute pain conditions, while they may underestimate it in the setting of chronic disease …”

Section: Observational Pain Assessment Toolsmentioning

confidence: 99%

The challenge of pain assessment in children with cognitive disabilities: Features and clinical applicability of different observational tools

Cascella

Bimonte

Saettini

et al. 2018

Children with cognitive disabilities are at greater risk of experiencing pain. It has been shown that this paediatric population often receive inadequate pain management. Pain may be very difficult to assess, especially in a defined subgroup with non-communicating intellectual disability or severe cognitive disability. Accordingly, several observational pain assessment tools have been proposed to overcome this issue. Due to the absence of an ideal measurement tool, accurate pain assessment requires, after a case-by-case analysis, selecting the more appropriate tool or a variety of combined instruments. The aim of this work is to provide a comprehensive review of the pain assessment tools commonly used in cognitively impaired children. Critical discussion on features and clinical applicability may suggest how to overcome this difficult challenge. Furthermore, this review will help further research aiming to design new instruments and to improve already-in-use tools.