Coping and adjustment in children's pain: processes of adaptation to illness and develop effective interventions for pain management

My PhD project mainly focused on understanding how a child or adolescent copes with pain associated with a disease, intended in a broader sense (i.e. procedures, treatments and disease-related). I tried to prove an innovative perspective that can help understand the wide variation in children’s pain experience, by considering intra-interpersonal influences, contextual factors, and intrapsychic factors that focus on needs, defenses, and self-structure. Overall, the whole project involved three pediatric units in Italy: the pediatric wards of Trento and Rovereto hospitals and the pediatric clinic of San Gerardo hospital, Monza (Milan). This doctoral thesis has achieved five goals: 1. Providing a selective overview on current relevant topics in the pediatric pain research and state of the art regarding the existing models of pediatric pain. 2. Developing a multi-dimensional protocol with an intra-method design for the assessment of pediatric pain in several chronic illnesses (cystic fibrosis, rheumatic diseases, cancer), by using also a battery of projective tests (drawings) to screen the emotional adjustment. 3. Validating the protocol by extending the methodology of projective drawings’ scoring with a control group and adding other assessment variables on a single cohort of patients (with malignant hematologic cancer) to test the new model that I developed. Quantitative analysis phase preceded qualitative analysis phase within the same framework to yield a parallel mixed analysis. 4. Planning specific training modules about pain management, starting from a bottom-up process concerning the local health professionals’ needs. I investigated these training needs through a series of open-ended questions, analyzed by a thematic analysis method. 5. Evaluate treatment’s feasibility, acceptability, and satisfaction of a problem-solving skills training for parents of children who have received an intensive pain rehabilitation from one pediatric pain rehabilitation program (Seattle Children's Hospital). I provided a methodological contribute within the mixed-method approach (statistical analysis and grounded theory). The results presented and their implications, are discussed in a clinical perspective since the rationale of this dissertation is that effective pain assessment must be multidimensional, multidisciplinary and at the same time feasible and practical to meet each pediatric patient’s needs

The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies

This systematic review will address the following questions:(i) To what extent is online-based pain instruction associated with improved outcomes in health professionals compared with no intervention?(ii) To what extent is online-based pain instruction associated with improved outcomes in health professionals compared with non-online instructional methods?(iii) What factors can explain potential differences in effect across participants, settings, interventions, outcomes, and study designs for each of these questions

The effectiveness of online pain resources for health professionals: a systematic review with subset meta-analysis of educational intervention studies

Online educational interventions are increasingly developed for health professionals and students, although graduate and undergraduate medical curricular often contain limited information about how to assess and manage pain. This study reviews the literature on the effectiveness of pain-related online educational resources. Studies were identified via a search of Medline, PsychINFO, Web of Science, CINAHL, PubMed, Scopus, Cochrane Library, Google Scholar and OpenGrey databases. Search terms included three concept blocks: (i) type of intervention - online education, computer-based, e-learning, web-based, and internet-based; (ii) population – pediatrician, physician, nurse, psychologist, medical; (iii) outcome - pain*. Thirty-two studies (13 randomised controlled trials, 5 non-randomised controlled trials, 14 single-group pre-post studies) were included. Ten provided data for inclusion in a series of between-groups meta-analyses. Post-intervention, participants receiving online instruction had significantly greater knowledge compared to those receiving training as usual/alternative training (Hedges’ g = 0.80, 95% CI: 0.12, 1.49), and students had significantly greater skills compared to students receiving training as usual (g = 1.34, CI: 0.38, 2.30). No significant differences were found for confidence/competence (g = 0.02, CI: -0.79. 0.84) or attitudes/beliefs (g = 0.16, CI: -0.48, 0.79). Although online educational resources show promise in improving learner knowledge, considerable heterogeneity exists between studies in quality, design, educational content, and outcomes. Further methodologically robust RCTs are required to establish the effectiveness of online educational interventions and a greater understanding of the key features of successful online resources, including cognitive interactivity. Few studies assessed health outcomes for patients, remaining a major priority for future investigations

The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The \u201cImpACT-COVID-19 for Patients\u201d Multi-Centre Observational Study

Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject's degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health