Impact of Race and Sex on Pain Management by Medical Trainees: A Mixed Methods Pilot Study of Decision Making and Awareness of Influence

Abstract Background To help pregnant women and their partners make informed value-congruent decisions about Down syndrome prenatal screening, our team developed two successive versions of a decision aid (DAv2017 and DAv2014). We aimed to assess pregnant women and their partners’ perceptions of the usefulness of the two DAs for preparing for decision making, their relative acceptability and their most desirable features. Methods This is a mixed methods pilot study. We recruited participants of study (women and their partners) when consulting for prenatal care in three clinical sites in Quebec City. To be eligible, women had to: (a) be at least 18 years old; (b) be more than 16 weeks pregnant; or having given birth in the previous year and (c) be able to speak and write in French or English. Both women and partners were invited to give their informed consent. We collected quantitative data on the usefulness of the DAs for preparing for decision making and their relative acceptability. We developed an interview grid based on the Technology Acceptance Model and Acceptability questionnaire to explore their perceptions of the most desirable features. We performed descriptive statistics and deductive analysis. Results Overall, 23 couples and 16 individual women participated in the study. The majority of participants were between 25 and 34 years old (79% of women and 59% of partners) and highly educated (66.7% of women and 54% of partners had a university-level education). DAv2017 scored higher for usefulness for preparing for decision making (86.2 ± 13 out of 100 for DAv2017 and 77.7 ± 14 for DAv2014). For most dimensions, DAv2017 was more acceptable than DAv2014 (e.g. the amount of information was found “just right” by 80% of participants for DAv2017 against 56% for DAv2014). However, participants preferred the presentation and the values clarification exercise of DAv2014. In their opinion, neither DA presented information in a completely balanced manner. They suggested adding more information about raising Down syndrome children, replacing frequencies with percentages, different values clarification methods, and a section for the partner. Conclusions A new user-centered version of the prenatal screening DA will integrate participants’ suggestions to reflect end users’ priorities.

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Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed methods pilot study protocol

BMJ Open ◽

10.1136/bmjopen-2020-046021 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046021

Author(s):

Brittany Humphries ◽

Montserrat León-García ◽

Shannon Bates ◽

Gordon Guyatt ◽

Mark Eckman ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Pilot Study ◽

Data Collection ◽

Decision Analysis ◽

Shared Decision Making ◽

Quantitative Data ◽

Integrated Approach ◽

Shared Decision ◽

Data Collection And Analysis

IntroductionDecision analysis is a quantitative approach to decision making that could bridge the gap between decisions based solely on evidence and the unique values and preferences of individual patients, a feature especially important when existing evidence cannot support clear recommendations and there is a close balance between harms and benefits for the treatments options under consideration. Low molecular weight heparin (LMWH) for the prevention of venous thromboembolism (VTE) during pregnancy represents one such situation. The objective of this paper is to describe the rationale and methodology of a pilot study that will explore the application of decision analysis to a shared decision-making process involving prophylactic LMWH for pregnant women or those considering pregnancy who have experienced a VTE.Methods and analysisWe will conduct an international, mixed methods, explanatory, sequential study, including quantitative data collection and analysis followed by qualitative data collection and analysis. In step I, we will ask women who are pregnant or considering pregnancy and have experienced VTE to participate in a shared decision-making intervention for prophylactic LMWH. The intervention consists of three components: a direct choice exercise, a values elicitation exercise and a personalised decision analysis. After administration of the intervention, we will ask women to make a treatment decision and measure decisional conflict, self-efficacy and satisfaction. In step II, which follows the analysis of quantitative data, we will use the results to inform the qualitative interview. Step III will be a qualitative descriptive study that explores participants’ experiences and perceptions of the intervention. In step IV, we will integrate findings from the qualitative and quantitative analyses to obtain meta-inferences.Ethics and disseminationSite-specific ethics boards have approved the study. All participants will provide informed consent. The research team will take an integrated approach to knowledge translation.

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The influence of continuous local wound infusion on postoperative pain in patients undergoing transfemoral amputation

VASA ◽

10.1024/0301-1526/a000457 ◽

2015 ◽

Vol 44 (5) ◽

pp. 381-386 ◽

Cited By ~ 1

Author(s):

Christian Uhl ◽

Thomas Betz ◽

Andrea Rupp ◽

Markus Steinbauer ◽

Ingolf Töpel

Keyword(s):

Pain Management ◽

Pilot Study ◽

Local Anaesthetic ◽

Phantom Pain ◽

Transfemoral Amputation ◽

Postoperative Wound ◽

Stump Pain ◽

Management Protocol ◽

Group 2 ◽

Group 1

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

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Bilateral Continuous Erector Spinae Blocks for Post-Sternotomy Pain Management: A Pilot Study

Case Medical Research ◽

10.31525/ct1-nct03936387 ◽

2019 ◽

Author(s):

Keyword(s):

Pain Management ◽

Pilot Study ◽

Erector Spinae

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Evaluation of the Impact of an Individual Peer Support Intervention for Stroke Patients When Returning Home: a Mixed Methods Pilot Study

Case Medical Research ◽

10.31525/ct1-nct04197258 ◽

2019 ◽

Author(s):

Keyword(s):

Mixed Methods ◽

Pilot Study ◽

Peer Support ◽

Stroke Patients ◽

Support Intervention ◽

Returning Home ◽

The Impact ◽

Peer Support Intervention

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Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Otolaryngology ◽

10.1177/0194599821996313 ◽

2021 ◽

Vol 164 (4) ◽

pp. 704-711

Author(s):

Samantha Anne ◽

Sandra A. Finestone ◽

Allison Paisley ◽

Taskin M. Monjur

Keyword(s):

Health Care ◽

Decision Making ◽

Clinical Practice ◽

Pain Management ◽

Health Care Providers ◽

Clinical Practice Guideline ◽

Shared Decision ◽

Care Providers ◽

Plain Language ◽

Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

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Pain Standards for Accredited Healthcare Organizations (ACDON Project): A Mixed Methods Study

Journal of Personalized Medicine ◽

10.3390/jpm11020102 ◽

2021 ◽

Vol 11 (2) ◽

pp. 102

Author(s):

Concepción Pérez ◽

Jimmy Martin-Delgado ◽

Mercedes Vinuesa ◽

Pedro J. Ibor ◽

Mercedes Guilabert ◽

...

Keyword(s):

Mixed Methods ◽

Pain Management ◽

Cancer Pain ◽

Delphi Technique ◽

Social Impact ◽

Poor Quality ◽

Nominal Group ◽

Cancer Pain Management ◽

Healthcare Organizations ◽

High Level

Up to 50% of cancer patients and up to 90% of those in terminal stages experience pain associated with disease progression, poor quality of life, and social impact on caregivers. This study aimed to establish standards for the accreditation of oncological pain management in healthcare organizations. A mixed methods approach was used. First, a pragmatic literature review was conducted. Second, consensus between professionals and patients was reached using the Nominal Group and Delphi technique in a step that involved anesthesiologists, oncologists, family physicians, nurses, psychologists, patient representatives, and caregivers. Third, eight hospitals participated in a pilot assessment of the level of fulfillment of each standard. A total of 37 standards were extracted. The Nominal Group produced additional standards, of which 60 were included in Questionnaire 0 that was used in the Delphi Technique. Two Delphi voting rounds were performed to reach a high level of consensus, and involved 64 and 62 participants with response rates of 90% and 87%, respectively. Finally, 39 standards for the management of cancer pain were agreed upon. In the self-evaluation, the average range of compliance was between 56.4% and 100%. The consensus standards of the ACDON Project might improve the monitoring of cancer pain management. These standards satisfied the demands of professionals and patients and could be used for the accreditation of approaches in cancer pain management.

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