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: 7847443
• 负责人: Ann Marie McCarthy
• 金额: $ 54.87万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-06-01 至 2012-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7847443
• 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; 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; effective intervention; efficacy testing; experience; genetic variant; high risk; interest; predictive modeling; programs; research study; response; secondary outcome; 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。不适当的疼痛管理会在孩子身上产生预期的焦虑，并可能产生负面的长期后果。分散注意力可以有效地减少儿童在接受手术时的疼痛和痛苦。许多父母可以接受培训，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。一些父母和孩子需要更强大的分心干预。我们目前的R 01确定的变量，预测孩子对父母分心教练的反应，以及父母成功提供分心的能力。这些预测因子已被纳入一个计算机化的分心预测模型（CPMD），预测儿童在痛苦的过程中出现痛苦的风险。拟议的研究将使用CPMD来预测高，中，低风险的困扰组，并测试水平的分心干预适合每个风险组。这项研究的目的是：1）评估两种分散注意力干预措施的有效性，专业和增强，为高风险组的儿童，2）评估三种分散注意力干预措施的有效性，专业，增强和基本为中等风险组的儿童，3）检查内皮素受体1（EDNRA）基因内的序列变体解释CPMD未解释的痛苦的程度，和4）识别和确认预测儿童对疼痛程序的痛苦反应的其他遗传变异。将在3个研究中心入组约580名4-10岁的儿童，计划使用静脉（IV）导管。CPMD将确定儿童的痛苦风险，并将按风险组分配亲子配对，以达到分心干预的水平。基本分心干预是目前R 01中使用的干预，包括一个简短的录像带，书面材料，并与研究人员进行简短的咨询。增强型分心干预是基本干预加上为父母定制的指导、手术期间对环境的修改和父母提示。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辅导。EDNRA的基因分型被发现在当前R 01中可预测儿童窘迫，将用于解释CPMD未考虑的窘迫，控制干预类型。将采用行为（行为苦恼观察量表）、生物（皮质醇水平）、儿童（Oucher）和父母（PRCD）苦恼和疼痛测量来测量儿童苦恼反应。将按风险组和干预水平比较父母-子女对干预措施的反应。

项目成果

Relationship of Genetic Variants With Procedural Pain, Anxiety, and Distress in Children.

• DOI: 10.1177/1099800417692878
• 发表时间: 2017-05
• 期刊: Biological research for nursing
• 影响因子: 2.5
• 作者: Ersig AL;Schutte DL;Standley J;Leslie E;Zimmerman B;Kleiber C;Hanrahan K;Murray JC;McCarthy AM
• 通讯作者: McCarthy AM

Validation of a clinically useful measure of children's state anxiety before medical procedures.

• DOI: 10.1111/jspn.12042
• 发表时间: 2013-10
• 期刊: Journal for specialists in pediatric nursing : JSPN
• 作者: Ersig AL;Kleiber C;McCarthy AM;Hanrahan K
• 通讯作者: Hanrahan K

Impact of Parent-Provided Distraction on Child Responses to an IV Insertion.

• DOI: 10.1080/02739611003679915
• 发表时间: 2010
• 期刊: Children's health care : journal of the Association for the Care of Children's Health
• 作者: McCarthy AM;Kleiber C;Hanrahan K;Zimmerman MB;Westhus N;Allen S
• 通讯作者: Allen S

Normative salivary cortisol values and responsivity in children.

• DOI: 10.1016/j.apnr.2007.04.009
• 发表时间: 2009-02
• 期刊: APPLIED NURSING RESEARCH
• 影响因子: 2.2
• 作者: McCarthy, Ann Marie;Hanrahan, Kirsten;Kleiber, Charmaine;Zimmerman, M. Bridget;Lutgendorf, Susan;Tsalikian, Eva
• 通讯作者: Tsalikian, Eva

Factors explaining children's responses to intravenous needle insertions.

• DOI: 10.1097/nnr.0b013e3181f80ed5
• 发表时间: 2010-11
• 期刊: Nursing research
• 影响因子: 2.5
• 作者: McCarthy AM;Kleiber C;Hanrahan K;Zimmerman MB;Westhus N;Allen S
• 通讯作者: Allen S