Stratton Catherine, Tyrrell Jennifer, Goren Rachel, Lalloo Chitra, Isaac Lisa
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Suite 130, M5T 1P8, Toronto, ON, Canada.
J Patient Rep Outcomes. 2022 Nov 29;6(1):120. doi: 10.1186/s41687-022-00520-4.
Patient engagement is an important tool for quality improvement (QI) and optimizing the uptake of research findings. The Plan-Do-Study-Act (PDSA) model is a QI tool that encourages ongoing evaluation of clinical care, thus improving various aspects of patient care. Ascertaining pediatric patient priorities for a pain questionnaire in the post-acute, or transitional pain, setting is important to guide clinical care since active engagement with the population of interest can optimize uptake. We used the PDSA model to adapt a chronic pain questionnaire for the pediatric transitional pain setting to reflect pediatric patient and parent/guardian preferences and to form an example of how the PDSA model can be used to improve clinical care through patient engagement.
This project employed the PDSA model to adapt the pediatric Ontario Chronic Pain Questionnaire for use in the pediatric Transitional Pain Service (pedTPS) setting. Plan: Following reviewing the Ontario Chronic Pain Questionnaire and literature on pain questionnaire development, goal-based questions, questions on pain location, relevant Patient-Reported Outcomes Measurement Information System (PROMIS) measures and the Pain Catastrophizing Scale, child (PCS-C) and parent (PCS-P), informed the questionnaire. Do: The questionnaire and a satisfaction survey were sent to patients and families through Research Electronic Data Capture (REDCap™).
Results from the satisfaction survey were analyzed. Act: Using descriptive statistics employing ordinal mixed-models with random effects, ANOVA, and double-blinded qualitative thematic coding, questionnaire preferences were analyzed and the questionnaire was adapted accordingly before implementation into the (pedTPS).
Eighty-eight questionnaires and satisfaction surveys were analyzed from 69 respondents (32 patients; 37 parents/guardians). Sixty-six (75.00%) surveys indicated satisfaction with the questionnaire. A combined 77 (87.50%) "strongly agreed" (25/88) or "agreed" (52/88) that the questionnaire language was clear. The application of suggested changes to the questionnaire resulted in four versions across the project timeline, which reflected patient and parent/guardian preferences for questions that reflect the themes, "Story"; "Time-Optimal"; and "Pertinent" ("STOP"). There were no statistically significant differences in satisfaction across the versions due to sample size.
Most respondents were satisfied with the questionnaire and prefer "STOP" questions. Future studies will focus on testing the questionnaire for validity and reliability across pedTPS populations.
患者参与是质量改进（QI）和优化研究结果应用的重要工具。计划-实施-研究-改进（PDSA）模型是一种QI工具，鼓励对临床护理进行持续评估，从而改善患者护理的各个方面。确定儿科患者在急性后期或过渡性疼痛环境下对疼痛问卷的优先事项对于指导临床护理很重要，因为与目标人群的积极参与可以优化应用。我们使用PDSA模型来调整一份慢性疼痛问卷，使其适用于儿科过渡性疼痛环境，以反映儿科患者及其父母/监护人的偏好，并形成一个如何通过患者参与利用PDSA模型改善临床护理的示例。
本项目采用PDSA模型来调整安大略省儿科慢性疼痛问卷，以用于儿科过渡性疼痛服务（pedTPS）环境。计划：在审查安大略省慢性疼痛问卷和有关疼痛问卷开发的文献、基于目标的问题、疼痛部位问题、相关患者报告结果测量信息系统（PROMIS）指标以及疼痛灾难化量表、儿童版（PCS-C）和父母版（PCS-P）后，确定问卷内容。实施：通过研究电子数据采集（REDCap™）将问卷和满意度调查发送给患者和家庭。
对满意度调查结果进行分析。改进：采用具有随机效应的有序混合模型、方差分析和双盲定性主题编码的描述性统计方法，分析问卷偏好，并在将问卷应用于（pedTPS）之前进行相应调整。
对来自69名受访者（32名患者；37名父母/监护人）的88份问卷和满意度调查进行了分析。66份（75.00%）调查表示对问卷满意。共有77份（87.50%）“强烈同意”（25/88）或“同意”（52/88）问卷语言清晰。在项目时间线内，对问卷应用建议的更改后产生了四个版本，这些版本反映了患者及其父母/监护人对反映“故事”“时间最优”和“相关”（“STOP”）主题问题的偏好。由于样本量的原因，各版本之间的满意度没有统计学上的显著差异。
大多数受访者对问卷满意，并更喜欢“STOP”问题。未来的研究将集中在对pedTPS人群测试问卷的有效性和可靠性。
