Primer on adult patient satisfaction in perioperative settings.

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients

Developmental and Cultural Perspectives on Children’s Postoperative Pain Management at Home

Outpatient surgery is extremely common in children, and approximately 4 million children experience significant pain after surgery in the USA each year. Management of children\u27s postoperative pain in the home setting is suboptimal and is impacted by characteristics of children and parents, as well as the larger family and cultural context. In particular, developmental status of the child, parental beliefs regarding pain expression and analgesic use in children, cultural values and language barriers can affect management of children\u27s postoperative pain. Targeting the myriad barriers to children\u27s pain management by capitalizing upon the use of tailored interventions may help bridge the gap between the translation of pain management guidelines to the home setting

Adult coping with childhood sexual abuse: A theoretical and empirical review

Coping has been suggested as an important element in understanding the long-term functioning of individuals with a history of child sexual abuse (CSA). The present review synthesizes the literature on coping with CSA, first by examining theories of coping with trauma, and, second by examining how these theories have been applied to studies of coping in samples of CSA victims. Thirty-nine studies were reviewed, including eleven descriptive studies of the coping strategies employed by individuals with a history of CSA, eighteen correlational studies of the relationship between coping strategies and long-term functioning of CSA victims, and ten investigations in which coping was examined as a mediational factor in relation to long-term outcomes. These studies provide initial information regarding early sexual abuse and subsequent coping processes. However, this literature is limited by several theoretical and methodological issues, including a failure to specify the process of coping as it occurs, a disparity between theory and research, and limited applicability to clinical practice. Future directions of research are discussed and include the need to understand coping as a process, identification of coping in relation to adaptive outcomes, and considerations of more complex mediational and moderational processes in the study of coping with CSA

Child Postoperative Pain: Impact of Child Temperament and Parent Mood on Pain After Surgery

Around 80% of children who undergo surgery experience moderate to severe postoperative pain. Various psychosocial factors contribute to exacerbations of this pain. A child’s inborn personality traits and style of interaction with the environment are known as temperament. Children who are less sociable and more distress-prone (e.g., those who cry, throw tantrums) are more likely to have an anxious temperament. This anxiety before and after surgery may lead to an increase in postoperative pain levels as well. Parent pain ratings do not always reflect true child pain. Overtime, a parent’s emotional state and mood may change how they perceive child pain. Parents who have more negative moods or are more distressed tend to report their child’s pain as worse and have a negative impact on a child’s pain. Therefore, parents play a crucial role in treatment after surgery. Given this, the purpose of this study was to see how child temperament factors are associated with postoperative pain and how parent mood moderates this relationship. These specific factors are analyzed in a sample of children ages 2-13 who underwent elective surgery at the Children’s Hospital of Orange County (N = 112). Prior to the surgery, parents completed online surveys assessing child temperament and parent mood. Postoperative pain measures were reported by both children and parents after surgery on days 1, 3, and 7. Child temperament factors did not interact with parent mood to predict postoperative pain. Emotionality and sociability were not significantly associated with parent pain measures or child pain after surgery (ps \u3e 0.05). However, other studies have shown that child temperament does affect pain in a hospital setting more than they do at home. Interestingly, pain in children was low at home after surgery (less than 3 on a scale of 0 to 10). It is possible that the impact of temperament and mood on pain were less potent once the child is at home following the surgery and pain is lower. Further investigation on the influence of temperament and mood on child pain is important to obtain more clarity and discover optimal methods of treating pain in children. Future work may benefit from investigating different surgical procedures that might lead to a greater diversity of pain once children are home

Sex as a Moderator in the Relationship between Post-operative Pain and Analgesics Administered in Children Undergoing Elective Surgery

About 85% of children who undergo elective surgery experience pain post-operatively and many do not receive proper pain management care after discharge. Most parents lack an understanding of proper pain care management using analgesics upon discharge. Research reveals that adults rate girls as more sensitive to pain and that they display a greater amount of pain in a pediatric post-operative environment. In adulthood, women report more sensations of pain and have a higher pain tolerance, which can be attributed to physiological characteristics. Nonetheless, the social differences by which boys and girls experience pain and express their pain cannot be denied. The purpose of this study is to understand the relationship between a child’s post-operative pain and the amount of analgesics given to the child, and how sex moderates this association. Parents of children ages 2-13 (59% male, 41% female) (N=112) were asked to evaluate the pain of their child and report the amount and type of analgesic use days 1, 3, and 7 post-operatively. The Parents Perceived Pain Management (PPPM) Scale was used to evaluate the child’s pain and analgesic use was self-reported. Using this scale in regression-based analysis, there was a significant association between pain and the amount of analgesic use given to the children on post-operative days 1 (ibuprofen: b = 0.24, t = 3.55, p \u3c 0.05, acetaminophen: b = 0.22, t = 5.38, p \u3c 0.05) and 3 (ibuprofen: b = 0.72, t = 4.81, p \u3c 0.05, acetaminophen: b = 0.34, t = 4.44, p \u3c 0.05); however; sex did not significantly moderate this association (ps \u3e .05). Evidence in this study does not suggest that boys receive different post-operative analgesic care from girls as a function of pain. Future analysis should analyze factors that interact with this association like the sex of the parent that is administering analgesics and the parent’s education of analgesic usage

Response to: Mindset Over Matter: Is Parental Health Mindset an Appropriate Target for Intervention?

Although we appreciate the thoughtful letter by Humphry and colleagues and are grateful for the opportunity to respond, we somewhat disagree with the interpretation of our findings by the authors

Cold Pressor Pain Response in Children with Cancer

Objective: The goal of this study was to examine pain responses in pediatric patients with cancer. Method: Children (ages 6 to 18) undergoing treatment for cancer (N=68) completed the cold pressor task. Results: Average pain tolerance was 118.22 seconds (SD=101.18) and 40% of the children kept their hand in the water the entire 4-minute ceiling. On a 0 to 10 numeric rating scale, children reported a pain severity of 5.07 (SD=3.47) at their first report of pain, a pain severity of 5.94 (SD=3.54) at their maximum report of pain, and a pain severity of 5.33 (SD=3.72) at the time they reached pain tolerance. Children receiving chemotherapy agents (N=56) with possible neuropathic effects exhibited higher pain tolerance compared with children not receiving such treatments (N=10), β=0.84, SE=0.38, Wald χ21=4.88, P=0.027, hazard ratio=2.33, 95% confidence interval (1.10-4.92). Conclusions: This study provides data on experimental pain responses in a sample of children undergoing cancer treatment and suggests that pain experience may be moderated by cancer treatment type

Parental Psychosocial Factors Moderate Opioid Administration Following Children’s Surgery

BACKGROUND: This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain. METHODS: Participants in this longitudinal analysis were children ages 2–12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset. RESULTS: Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child’s pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant. CONCLUSIONS: These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery

Surgical Patients’ Hospital Experience Scores: Neighborhood Context Conceptual Framework

Objective: Through geocoding the physical residential address included in the electronic medical record to the census tract level, we present a novel model for concomitant examination of individual patient-related and residential context-related factors that are associated with patient-reported experience scores. Summary Background Data: When assessing patient experience in the surgical setting, researchers need to examine the potential influence of neighborhood-level characteristics on patient experience-of-care ratings. Methods: We geocoded the residential address included in the electronic medical record (EMR) from a tertiary care facility to the census tract level of Orange County, CA. We then linked each individual record to the matching census tract and use hierarchical regression analyses to test the impact of distinct neighborhood conditions on patient experience. This approach allows us to estimate how each neighborhood characteristic uniquely influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Results: Individuals residing in communities characterized by high levels of socioeconomic disadvantage have the highest experience ratings. Accounting for individual patient’s characteristics such as age, gender, race/ethnicity, primary language spoken at home, length of stay, and average pain levels during their hospital stay, neighborhood-level characteristics such as proportions of people receiving public assistance influence the ratings of hospital experience (0.01, P \u3c 0.05) independent of, and beyond, these individual-level factors. Conclusions: This manuscript is an example of how geocoding could be used to analyze surgical patient experience scores. In this analysis, we have shown that neighborhood-level characteristics influence the ratings of hospital experience independent of, and beyond, individual-level factors

Emotion Regulation and Positive Affect in the Context of Salivary Alpha-Amylase Response to Pain in Children with Cancer: Physiology, Self-Report, and Behavior

Children with cancer are repeatedly exposed to aversive stimuli including painful procedures. Therefore, emotional regulation techniques may prove useful during such experiences and contribute to pain resilience. This study aimed to determine whether three different emotional regulation strategies (distraction, reappraisal and reassurance) impacted physiological, self- reported and behavioral pain responses in pediatric patients with cancer ages 6 to 18 years (N = 73). The cold pressor task (CPT), an experimental task in which pain is induced by having participants place their hand in cold water, was used to examine pain responses. Patients placed their hand in 7 degree Celsius water for up to 4 minutes. Saliva samples were collected 15 minutes before, immediately after, and then 15 minutes after the CPT. Saliva samples were assayed for alpha amylase, a proxy for sympathetic nervous system activation. Self-reported pain severity was measured upon hand removal. Pain tolerance was assessed by length of time participants kept their hand in the water. Children in the reassurance condition exhibited salivary alpha amylase levels that continued to rise post completion of the CPT as compared to children in the distraction (Beta = -1.68, SE = 0.73, z = -2.30, p = .021, 95% CI [-3.10, -0.25]) and reappraisal (Beta = -1.24, SE = 0.72, z = -1.73, p = .084, 95% CI [-2.65, 0.17]) conditions. However, when self-reported pain and behavior were examined, no differences in pain severity (Wald Chi-squared (2) = 2.47, p = .292), or pain tolerance (Wald Chi-squared (2) = 1.38, p = 0.502) among the emotional regulation strategies were observed. Thus, significant findings were present for physiological markers of distress, but not for self-reported and behavioral measures. These findings suggest that in terms of physiological measures, specific emotional regulation strategies, such as distraction and reappraisal, may be more beneficial in reducing stress responses to painful medical procedures in pediatric patients with cancer as compared to reassurance. These results also demonstrate the importance of examining physiological outcomes in addition to self-report and behavioral outcomes