Hematopoietic stem cell transplantation (HSCT) is a painful, trying procedure that can be especially tedious for pediatric patients. To understand how pain levels are assessed in this population, a team from Melbourne, Australia, conducted a qualitative case study in a tertiary pediatric HSCT unit.
Patients’ parents were interviewed at 2 time points: 30 days after HSCT and 90 days after HSCT. Health care providers were also interviewed about their observations of pain in their patients.
According to the study, “The assessment of pain after transplantation by healthcare providers and parents was predominantly reliant on the observation of children for behaviors indicative of pain, rather than the application of validated pain assessment tools.”
Whereas pain in adults is typically judged based on validated pain assessment tools, it appears that, at the HSCT unit in this study, pain was typically based on subjective judgments from the health care providers and parents based on the children’s reactions.
“Without formal measures of the pain experience, judgments regarding the severity of children’s pain were influenced by the context of high acuity of care posttransplantation and the emotional responses of healthcare providers and parents from bearing witness to children’s pain,” the authors reported.
Therefore, the ability to tolerate pain was the predominant factor in pain assessment in these children.
“This study has emphasized how the assessment of pain for children hospitalized during HSCT therapy is limited by the complexity of the clinical environment. It is recommended that validated methods of assessing pain by healthcare providers and parents be implemented into clinical practice to ensure children’s pain is visible,” the study concluded.
