Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia.
Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.
Pediatr Blood Cancer. 2023 Nov;70(11):e30614. doi: 10.1002/pbc.30614. Epub 2023 Aug 7.
Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment.
To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices.
A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14).
The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain.
There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
接受造血干细胞移植（HSCT）治疗的儿童会因治疗强度而经历复杂且持久的疼痛。
描述在 HSCT 治疗期间如何对儿童进行疼痛管理，以及与临床环境相关的背景因素如何影响医疗保健提供者和家长的疼痛管理实践。
进行了一项定性案例研究，在移植后（30 和 90 天）分两个时间点对父母（n=10）进行半结构化访谈，并对儿童在 HSCT 治疗期间（n=29）由其医疗保健提供者（n=10）提供的与疼痛相关的护理进行自然观察。还对医疗保健提供者（n=14）进行了半结构化访谈。
疼痛管理干预措施的有效性受到儿童经历的多因素疼痛的性质、缺乏针对疼痛的心理社会干预措施以及缺乏用于持续（通常是长期）给予阿片类药物和辅助药物的循证指南的限制。医疗保健提供者对根据疼痛严重程度逐步升级疼痛管理以及区分阿片类药物耐受和成瘾存在误解。父母积极参与儿童的疼痛管理，尤其是提供非药物干预措施。与外部疼痛服务的合作以及在保护性隔离中照顾儿童的影响会延迟疼痛的及时管理。
迫切需要制定移植后管理疼痛的循证支持性护理指南，以优化儿童的疼痛缓解。如果要让父母和儿童参与疼痛管理，就必须加大力度培养他们做出明智决策的能力。
