Predicting Children's Response to Distration from Pain: Tailored Intervention

预测儿童对缓解疼痛的反应：量身定制的干预措施

• 批准号: 7319139
• 负责人: Ann Marie McCarthy
• 金额: $ 67.12万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-07-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7319139
• 关键词: 10 year old; Accounting; Anxiety; Behavioral; Behavioral Genetics; Biological; Candidate Disease Gene; Catheters; Child; Cognitive Therapy; Consultations; Data; Data Set; Diagnosis; Distress; Educational Materials; Educational process of instructing; Effectiveness; Effectiveness of Interventions; Endothelin A Receptor; Enrollment; Environment; Environmental Risk Factor; Family; Foundations; Funding; Genes; Genetic; Genotype; Health Professional; Human Resources; Hydrocortisone; Intervention; Intervention Studies; Intravenous; Knowledge; Link; Measures; Medical; Methods; Modification; Molecular; Molecular Genetics; Outcome; Outcome Measure; Pain; Pain management; Parents; Patient Self-Report; Phenotype; Population; Procedures; Purpose; Randomized; Randomized Clinical Trials; Reporting; Research; Research Personnel; Risk; Schedule; Single Nucleotide Polymorphism; Site; Staging; Testing; Time; Training; Translational Research; United States; Variant; Videotape; Writing; base; computerized; distraction; experience; genetic variant; interest; predictive modeling; programs; research study; response; tool

DESCRIPTION (provided by applicant): Annually more than 4 million US children require repeated painful medical procedures. Inadequate pain management can create anticipatory anxiety in the child and may have negative long-term consequences. Distraction is effective in reducing pain and distress for children undergoing procedures. Many parents can be trained to be distraction coaches for their children. However, some children do not respond to the distraction efforts of their parents, and not all parents are able to coach their children. Some parents and children need more powerful distraction interventions. Our current R01 identified variables that predict child response to parent distraction coaching, as well as parent ability to successfully provide distraction. These predictors have been incorporated into a Computerized Predictive Model for Distraction (CPMD) that predicts child risk for distress in response to a painful procedure. The proposed study will use the CPMD to predict high, medium, or low risk for distress groups and to test the level of distraction intervention appropriate for each risk group. The aims of this study are to: 1) Evaluate the effectiveness of two distraction interventions, Professional and Enhanced, for children in the high risk group, 2) Evaluate the effectiveness of the three distraction interventions, Professional, Enhanced and Basic for children in the medium risk group, 3) Examine the extent to which the sequence variants within the Endothelin Receptor 1(EDNRA) gene explain distress not accounted for by the CPMD, and 4) Identify and confirm additional genetic variants that predict child distress response to a painful procedure. Approximately 580 children, 4-10 years old and scheduled to have an intravenous (IV) catheter, will be enrolled at 3 sites. The CPMD will identify child risk for distress and will assign parent-child dyads, by risk group, to levels of distraction intervention. The Basic Distraction Intervention is the intervention used in the current R01 that includes a short videotape, written material, and brief consultation with a researcher. The Enhanced Distraction Intervention is the Basic Intervention plus customized directions for the parent, modifications to the environment and parent prompts during the procedure. The Professional Intervention is expert distraction coaching by an experienced, trained healthcare professional. Genotyping of EDNRA, found to be predictive of child distress in the current R01, will be used to explain distress that is not accounted for by the CPMD, controlling for type of intervention. Child distress response will be measured with behavioral (Observational Scale of Behavioral Distress), biological (cortisol levels), child (Oucher) and parent (PRCD) measures of distress and pain. The responses of parent-child dyads to the interventions will be compared by risk group and level of intervention.

描述（由申请人提供）：每年有超过400万美国儿童需要重复痛苦的医疗程序。不适当的疼痛管理可以在儿童中产生预期焦虑，并可能产生负面的长期后果。分散注意力可以有效地减轻接受手术的儿童的疼痛和痛苦。许多父母都可以接受训练，成为孩子的分心教练。然而，有些孩子对父母分散注意力的努力没有反应，并不是所有的父母都能指导他们的孩子。一些家长和孩子需要更强大的干扰干预。我们目前的R01确定了预测孩子对父母分心指导的反应的变量，以及父母成功提供分心的能力。这些预测因素已被纳入计算机化的注意力分散预测模型（CPMD），该模型可以预测儿童在痛苦手术后的痛苦风险。拟议的研究将使用CPMD来预测高、中、低风险的痛苦群体，并测试适合每个风险群体的分心干预水平。本研究的目的是：1)评估专业和强化两种分心干预对高危组儿童的有效性；2)评估中等风险组儿童专业、强化和基本三种分心干预的有效性；3)检查内皮素受体1（EDNRA）基因序列变异在多大程度上解释CPMD未解释的痛苦。4)识别和确认其他基因变异，预测儿童对痛苦手术的痛苦反应。大约580名4-10岁的儿童将在3个地点接受静脉注射（IV）导管。CPMD将确定儿童的痛苦风险，并将根据风险组分配父母-子女对分散注意力干预的水平。基本分心干预是目前R01中使用的干预措施，包括一个简短的录像带，书面材料，以及与研究人员的简短咨询。强化分心干预是在基本干预的基础上，再加上为家长定制的指导、环境的改变和过程中的家长提示。专业干预是由经验丰富、训练有素的医疗保健专业人员进行的专家分心指导。EDNRA的基因分型，在当前的R01中被发现可以预测儿童的痛苦，将被用来解释CPMD没有解释的痛苦，控制干预的类型。儿童的痛苦反应将通过行为（行为痛苦观察量表）、生物（皮质醇水平）、儿童（Oucher）和家长（PRCD）的痛苦和疼痛测量来测量。亲子对干预的反应将按风险组和干预水平进行比较。