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: 7477981
• 负责人: Ann Marie McCarthy
• 金额: $ 62.28万
• 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 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7477981
• 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进行痛苦的医疗手术。疼痛管理不充分可能会给孩子带来预期性焦虑，并可能产生长期的负面后果。分散注意力可以有效减轻接受手术的儿童的疼痛和痛苦。许多父母都可以接受培训，成为孩子的注意力分散教练。然而，有些孩子对父母的分散注意力的努力没有反应，而且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措施。我们当前的 R01 确定了一些变量，这些变量可以预测孩子对父母分散注意力辅导的反应，以及父母成功提供分散注意力的能力。这些预测因素已被纳入计算机分心预测模型 (CPMD)，该模型可预测儿童因痛苦手术而感到痛苦的风险。拟议的研究将使用 CPMD 来预测困扰群体的高、中或低风险，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) 评估两种分心干预措施（专业和增强）对于高风险组儿童的有效性，2) 评估三种分心干预措施（专业、增强和基本）对中等风险组儿童的有效性，3) 检查内皮素受体 1 (EDNRA) 基因内的序列变异在多大程度上解释 CPMD 无法解释的痛苦，以及 4) 识别和确认其他遗传因素 预测儿童对痛苦手术的痛苦反应的变异。将在 3 个地点招募大约 580 名 4-10 岁并计划接受静脉 (IV) 导管的儿童。 CPMD 将识别儿童遭受痛苦的风险，并按风险组将亲子二人组分配到分心干预的级别。基本分心干预是当前 R01 中使用的干预措施，包括短片、书面材料以及与研究人员的简短咨询。增强型分心干预是基本干预加上针对家长的定制指导、对环境的修改以及手术过程中家长的提示。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业分散注意力辅导。 EDNRA 的基因分型被发现可以预测当前 R01 中的儿童痛苦，将用于解释 CPMD 未解释的痛苦，并控制干预类型。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衡量。将按风险组和干预水平比较亲子二人组对干预措施的反应。