Management of Post Operative Pain in Underserved Populations

描述(由申请人提供)：在美国接受手术的500多万儿童中，估计有高达65%的儿童在住院期间和稍后在家中会经历严重的疼痛。在过去的十年里，门诊手术变得更加普遍，因此，在家管理术后疼痛的重担主要落在了父母身上。不幸的是，我们实验室和其他实验室的一些研究表明，许多儿童手术后的疼痛在家庭环境中明显得不到治疗。考虑到美国近25%的5岁以下儿童是西班牙裔，了解种族和文化在家庭环境下术后疼痛体验中的作用尤为重要。在成年人中，不同环境和不同类型的疼痛在感知、评估和治疗方面存在种族差异是公认的。事实上，医学研究所建议将疼痛管理中种族差异的来源调查和潜在的干预策略作为研究重点。目前，在这一领域对儿童的研究或干预非常缺乏。我们的实验室已经证明，具有低社会经济地位(SES)的西班牙裔儿童的父母更有可能对疼痛管理产生误解，并且在接受手术后，这些儿童在家中接受止痛药的可能性明显更小。作为下一步，我们提出有必要了解这一独特人群中疼痛管理的障碍，并制定具体的干预措施。此R21应用的目标是确定低SES的西班牙裔儿童术后疼痛管理的障碍。这项研究将采用定量和定性两种方法。在后续的R01调查中，我们计划开发和测试针对这些服务不足的人群的量身定做的干预措施。公共卫生相关性：在研究结束时，我们将确定在服务不足的人群中进行家庭疼痛管理的具体障碍。此外，这些信息将使我们能够开发一种数据驱动的干预措施，改善目前西班牙裔儿童在家疼痛管理方面的差距。 公共卫生相关性：本研究试图确定西班牙裔低SES儿童手术后疼痛管理的种族差异的来源。了解潜在的障碍(即误解、沟通错误、文化价值观)将使我们能够在后续应用中开发一种创新的、基于证据的、文化定制的干预措施，以解决成功疼痛管理的这些障碍。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: 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. PUBLIC HEALTH RELEVANCE: 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.