Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study.

Objectives: Pain affects all children and youth, yet acute and procedural pain remains undertreated in Canadian hospitals. To improve pain management practices in paediatric hospitals, it is necessary to understand how healthcare professionals (HCPs) wish for educational interventions to be designed to improve their pain management practice. Methods: Semi-structured interviews were conducted with 18 HCPs between October and December 2020. Snowball sampling was used to first recruit interested members from the hospital's Pediatric Pain Management Committee. Interviews were conducted per participant preference and included Zoom, telephone, and in-person interviews. Recruitment ceased when data were determined sufficiently rich. A thematic analysis of verbatim transcripts and reflexive field notes were used to create a data set focused on knowledge mobilization and clinical education. Results: Three core themes were identified: (a) the necessity for just-in-time education for HCPs; (b) the availability of clinical pain champions to educate staff; and (c) the provision of resources to educate children and their families about available pain management interventions. Just-in-time education included suggestions for in-service training, hands-on training, and regular updates on the latest research. Pain champions, including clinical nurse educators, were stressed as being important in motivating staff to improve their pain management practices. Participants noted the lack of resources for patient and family education on pain management and suggested providing more multimodal resources and educational opportunities. Conclusion: Having local champions introduce pain management initiatives and just-in-time education positively impacts the implementation climate, which also helps HCPs provide evidence-based education and resources to patients and families.

Perceptions of Adolescents With Chronic Pain About Peer Support: Reflexive Thematic Analysis.

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.

Roadmap to the 'Chronic Pain GPS for Adolescents' Intervention: Content and Design Considerations for a Group Peer Support Intervention.

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.

Evaluating the impacts of patient engagement on a national health research network: results of a case study of the Chronic Pain Network.

BACKGROUND: The Chronic Pain Network (CPN) is a pan-Canadian research network focused on innovating and improving the quality and delivery of pain prevention, assessment, management and research for all Canadians. An important focus of the CPN is to work in collaboration with patient partners. Patient partners, researchers and clinicians work together in all aspects of the research network including on funded research projects and in the governance of the Network. Given this focus, the CPN identified the importance of evaluating their patient engagement work to understand its functioning and impact. METHODS: The objective of this exploratory evaluation case study was to understand the impacts of patient engagement on the CPN. The CPN worked with an external evaluation team which established an arms-length approach to the evaluation. Interviews were conducted with CPN members, including patient partners, leadership, funded researchers and committee co-chairs, at three discrete time points to trace the evolution of the patient engagement program within the Network. Key Network documents were also collected and reviewed. Data were analyzed following each set of interviews using content analysis guided by the principles of constant comparison and qualitative description. A final round of analysis was conducted using the Engage with Impact Toolkit, an impact measurement framework, to identify impacts of engagement. RESULTS: Impacts of patient engagement were identified at the individual, network, funded research project and research community levels. These impacts were observed in the following areas: (1) building community; (2) developing knowledge, skills and resources; (3) increasing confidence; (4) influencing priorities and decisions; (5) enabling additional opportunities; (6) promoting culture change; and, (7) coping with experiences of living with chronic pain. CONCLUSIONS: While not without challenges, the patient engagement efforts of the CPN demonstrates the impact engaging patient partners can have on a national research network and related policy activities. Understanding the approaches to, and impacts of, patient engagement on health research networks can illuminate the value of having patient partners engaged in all aspects of a research network and should serve as encouragement to others who look to take on similar work.

The Chronic Pain Network (CPN) is one of a group of research networks that was funded by the Canadian Institutes of Health Research (CIHR) to support patient-oriented research in chronic diseases. From the beginning of its work, the CPN has included patients as partners. Patient partners are co-chairs of all Network governance committees, funded projects are required to include patient partners in their work and there is a committee dedicated to engagement, the Patient Engagement (PE) committee. The PE Committee determined that it was important to evaluate how the CPN was engaging with patient partners and collaborated with the Public and Patient Engagement Collaborative (PPEC) to evaluate this work. The PPEC, along with members of the PE Committee, identified understanding the impact of patient engagement as an important part of the evaluation. This paper provides a description of the impacts of patient engagement on the people who were involved in the CPN, on the CPN's work and way of being, and on the broader pain research community. Based on the results from three sets of interviews and review of Network documents, we share impacts identified in seven areas: (1) building community; (2) developing knowledge, skills and resources; (3) increasing confidence; (4) influencing priorities and decisions; (5) enabling additional opportunities; (6) promoting culture change; and, (7) coping with experiences of living with chronic pain. This research shows us the impact that engaging patient partners can have on a national research network, and the areas where greater focus could, perhaps, lead to even greater impacts in future networks.

The State of Patient Engagement among Pain Research Trainees in Canada: Results of a National Web-Based Survey.

Background: Patient engagement (PE) in research refers to partnering with people with lived experience (e.g., patients, caregivers, family) as collaborators in the research process. Although PE is increasingly being recognized as an important aspect of health research, the current state of PE among pain research trainees in Canada is unclear. Aims: The aims of this study were to describe perspectives about and experiences with PE among trainees conducting pain research in Canada, to identify perceived barriers and facilitators, and to describe recommendations to improve its implementation. Methods: A cross-sectional web-based survey (English and French) was administered to trainees at any level conducting pain research at any Canadian academic institution. Results: A total of 128 responses were received; 115 responses were complete and included in the final analysis. The majority of respondents identified as women (90/115; 78.3%), in graduate school (83/115; 72.2%), and conducting clinical pain research (83/115; 72.2%). Most respondents (103/115; 89.6%) indicated that PE is "very" or "extremely" important. Despite this, only a minority of respondents (23/111; 20.7%) indicated that they "often" or "always" implement PE within their own research. The most common barrier identified was lack of knowledge regarding the practical implementation of PE, and understanding its positive value was the most commonly reported facilitator. Recommendations for improving the implementation of PE were diverse. Conclusions: Despite viewing PE as important in research, a minority of pain research trainees regularly implement PE. Results highlight perceived barriers and facilitators to PE and provide insight to inform the development of future training and other enabling initiatives.

Contexte: L'engagement des patients dans la recherche fait référence au partenariat avec des personnes ayant une expérience vécue (p. ex. des patients, des soignants ou des membres de la famille) en tant que collaborateurs dans le processus de recherche. Bien que l'engagement des patients soit de plus en plus reconnu comme un aspect important de la recherche en santé, son état actuel chez les stagiaires en recherche sur la douleur au Canada n'est pas clair.Objectif: Les objectifs de cette étude étaient de décrire les points de vue et les expériences sur l'engagement des patients chez les stagiaires menant des études sur la douleur au Canada, de recenser les obstacles et les facilitateurs perçus et de formuler des recommandations pour améliorer sa mise en œuvre.Méthodes: Une enquête transversale sur le Web (en anglais et en français) a été menée auprès des stagiaires de tout niveau menant des études sur la douleur dans n'importe quel établissement universitaire canadien.Résultats: Au total, 128 réponses ont été reçues; 115 réponses étaient complètes et ont été incluses dans l'analyse finale. La majorité des répondants ont indiqué qu'elles étaient des femmes (90/115; 78,3 %), qu'elles étaient inscrites aux cycles supérieures (83/115 ; 72,2 %) et qu'elles effectuaient des études cliniques sur la douleur (83/115 ; 72,2 %). La plupart des répondants (103/115 ; 89,6 %) ont indiqué que l'engagement était « très ¼ ou « extrêmement ¼ important. Malgré cela, seule une minorité de répondants (23/111; 20,7 %) ont indiqué qu'ils mettaient en œuvre l'engagement des patients « souvent ¼ ou « toujours ¼ dans leur propre recherche. L'obstacle le plus fréquemment énoncé était le manque de connaissances concernant la mise en œuvre pratique de l'engagement des patients, et la compréhension de sa valeur positive était le facilitateur le plus souvent signalé. Les recommandations visant à améliorer la mise en œuvre de l'engagement des patients étaient diverses.Conclusions: Bien que l'engagement des patients soit considéré comme important dans la recherche, une minorité de stagiaires en recherche sur la douleur le mettent régulièrement en œuvre. Les résultats mettent en évidence les obstacles et les facilitateurs perçus pour l'engagement des patients et fournissent un aperçu pour éclairer l'élaboration de la formation future et d'autres initiatives habilitantes.

Ambiguity Tolerance and Prospective Specialty Choice Among Third-Year Medical Students.

INTRODUCTION: Poor tolerance of ambiguity is consequential in clinical practice, and has been linked to avoidance of family medicine, in which there is inherently more ambiguity. This study aimed to investigate the relationship between tolerance of ambiguity and prospective specialty choice of medical students in their third year of medical school. This stage of medical training is of particular importance as students develop clinical reasoning skills and encounter clinical ambiguity. METHODS: This was a cross-sectional study using an online survey. Sixty-one third-year medical students (62% response rate) from a large Canadian university completed the survey with a validated measure of ambiguity tolerance (the 29-item Tolerance of Ambiguity in Medical Students and Doctors scale) and their top three specialty choices. Specialty choices were subsequently grouped into two categories: family medicine (FM) and non-family medicine (non-FM) specialties. RESULTS: There was no significant mean difference in tolerance of ambiguity between students who reported interest in FM and students interested in non-FM specialties. Similarly, we observed no significant difference in tolerance of ambiguity between female and male students. Older students reported higher levels of ambiguity tolerance. Older students were also more likely to report FM as one of their top three specialty choices. CONCLUSION: Qualitative studies are needed to explore possible reasons for the observed results, including the effects of digital information resources and clinical decision-making tools on medical students' ambiguity tolerance. Medical educators should be aware that some students may require explicit training in how to respond to ambiguity.

Parental autonomy support in relation to preschool aged children's behavior: Examining positive guidance, negative control, and responsiveness.

This study evaluated the relationship between parental autonomy support and preschool-aged children's display of autonomy. Specifically, we examined if mothers' and fathers' use of positive guidance, negative control, and responsiveness during parent-child interactions predicted children's autonomous behavior. One hundred families comprised of mothers, fathers, and their children participated. Parent-child dyads were filmed engaging in an unstructured play task and interactions were coded using the Parent-Child Interaction System. Mothers' use of negative control and father's use of positive guidance, negative control, and responsiveness predicted children's displays of autonomy, whereas mothers' positive guidance and responsiveness did not. The results offer insight into how parents play unique roles in promoting their children's autonomy, which has implications for practitioners and researchers who work with families. Our findings provide examples of behaviors that parents can employ to promote their children's autonomy.

Guidance on authorship with and acknowledgement of patient partners in patient-oriented research.

The Strategy for Patient-Oriented Research Chronic Pain Network was founded in 2016 and is a patient-oriented research network funded by the Canadian Institutes of Health Research. The Network incorporates patient partners throughout its governance and operations meaning that patient partners may contribute to research projects in ways that warrant scientific authorship as defined by the International Committee of Medical Journal Editors. The Network did a brief informal review of guidance on patient authorship in 2019, but could not find any practical documentation to guide its members on this topic. Note the term patient partner here refers to a patient (or caregiver or other person with lived experience) who is a partner or collaborator on a research team. This guidance does not address patients as participants in a research study. This guidance has been co-written by a group of researchers and patient partners of the Chronic Pain Network in an effort to address this gap. It is intended for both researchers and patient partner audiences. This guidance is meant to facilitate conversations between researchers and patient partners about authorship and/or acknowledgement regarding research projects on which they collaborate. While the overall principles of academic authorship and acknowledgement remain unchanged, nuances for interpreting these principles through the lens of patient engagement or patient-oriented research is provided. Teams that carry out patient-oriented research projects will require different preparation to empower all team members (researchers and patient partners) to discuss authorship and acknowledgement. To facilitate these conversations, we have included an overview of the scientific publishing process, explanation of some common terms, and sets of considerations are provided for both patient partners and researchers in determining the range of team member contribution from acknowledgement to authorship. Conversations about authorship can be difficult, even for established research teams. This guidance, and the resources discussed within it, are provided with the intention of making these conversations easier and more thoughtful.