Parentsí Analgesic Decision Dilemmas: Trading Childrenís Pain Relief for Risk Reduction.

Abstract

Background: Effective pain management requires analgesic decisions that balance the need to maximize pain relief and safety. However, reports of unrelieved childhood pain, analgesic misuse, and serious analgesic-related adverse drug effects (ADE) suggest that parental analgesic trade-off decisions are often inadequate. Based on decision theory, this dissertation examined parents’ analgesic decisions and explored factors that influenced their responsiveness to varying pain and ADE signals. Methods: Parents of children undergoing painful, short-stay surgery (N=468) completed surveys regarding their understanding of the possible opioid-related ADEs (gist knowledge), their perceptions of ADE seriousness, and their preferences for providing pain relief versus avoiding ADEs. Analyses compared both responses to hypothetical scenarios and real postoperative opioid decisions to see how parents responded to varying pain and ADE signals and to explore how gist analgesic understanding and preferences influenced their decisions to give opioids. Results: Parents were more likely to give opioids (hypothetically and postoperatively) when faced with higher pain and to withhold opioids when presented with ADEs, suggesting a general recognition of pain and ADE signals. However, parents were more likely to withhold the prescribed opioid dose for symptoms of nausea/vomiting than oversedation (odds ratio 0.68; p = 0.018), suggesting that oversedation symptoms may be less salient than nausea/vomiting. Perceived seriousness, but not gist possibility knowledge, influenced the decision to withhold opioids for oversedation, demonstrating that gist awareness of ADEs in itself may be insufficient to influence safe opioid use. Strong preference for pain relief over ADE avoidance weakened the effect of analgesic knowledge/perception on the decision to withhold opioids for oversedation, showing how preferences may interfere with knowledge when symptoms are less salient. Conclusion: Many parents lack a critical understanding of serious analgesic-related ADEs, such as oversedation, placing them at risk for making unsafe or ineffective treatment decisions. Parents need a clearer understanding of possible ADEs, their potential seriousness and consequences in order to safely and effectively manage pain postoperatively. These findings should be used to guide the development of interventions to optimize parent decision-making and symptom surveillance regarding pain medications and, in turn, enhance children’s comfort and safety.