Of the over five million children who undergo surgery in the United States, it is estimated that up to 65% will experience significant pain while in hospital and later at home. Over the past decade outpatient surgery has become much more prevalent and as a result the burden of managing postoperative pain at home falls mostly on the parents. Unfortunately, a number of studies by our laboratory as well as others indicate that many children's pain after surgery is significantly undertreated in home settings. Understanding the role of ethnicity and culture in the experience of postoperative pain at home settings is of particular importance when one considers that nearly 25% of children under the age of 5 in the United States are Hispanic. In adults, the existence of ethnic differences in perception, assessment, and treatment across settings and types of pain is well established. Indeed, the Institute of Medicine has recommended that the investigation of the sources of ethnic disparities in pain management and potential intervention strategies be a research priority. At the current time there is significant paucity of studies or interventions in this area in children. Our laboratry has demonstrated that parents of children of Hispanic origin with low socioeconomic status (SES) are significantly more likely to have misconceptions about pain management and after undergoing surgery these children are significantly more likely to receive less analgesics while at home. As a next step, we submit the need to understand the barriers for pain management in this unique population and next develop a specific intervention. The goal of this R21 application is to identify barriers to postoperative pain management in children of Hispanic origin of low SES. The study will employ both quantitative and qualitative approaches. In a follow up R01 investigation, we plan to develop and test a tailored intervention that will be directed at this underserved population.
At the conclusion of the study, we will have identified specific barriers to pain management at home in an underserved population. Additionally, this information will allow us to develop a data-driven intervention that will improv the present disparity in pain management of Hispanic children at home.
The present study seeks to identify the sources of ethnic disparities in pain management after surgery among children of Hispanic origin of low SES. Understanding potential barriers (i.e., misconceptions, miscommunication, cultural values) will allow us to develop in a follow up application an innovative, evidence- based, culturally-tailored intervention that will address these barriers to successful pain management.
|Brown, Rebecca; Fortier, Michelle A; Zolghadr, Sheeva et al. (2016) Postoperative Pain Management in Children of Hispanic Origin: A Descriptive Cohort Study. Anesth Analg 122:497-502|
|Rosales, Alvina; Fortier, Michelle A; Campos, Belinda et al. (2016) Postoperative pain management in Latino families: parent beliefs about analgesics predict analgesic doses provided to children. Paediatr Anaesth 26:307-14|
|Hutchins, Jacob; Castro, Chandra; Wang, Qi et al. (2016) Postoperative pain control with paravertebral catheters after pediatric total pancreatectomy and islet autotransplantation: a retrospective cohort study. Paediatr Anaesth 26:315-20|