Design and implementation of a novel patient-centered empowerment approach for pain optimisation in children undergoing major surgery

BMJ Open Quality

article

Vidya Chidambaran¹  Blair Simpson²  Laura Brower¹  Rachel Hanke⁴  Marc Mecoli¹  Blake Lane⁵  Sara Williams²  Emily McKenna⁴  Christina Bates⁴  Aimee Kraemer⁴  Peter Sturm²  Rebeccah Brown²  Linda Dunseath⁵  Craig Vogel⁵  Victor Garcia² 

[1] Department of Anesthesiology , Cincinnati Children’s Hospital Medical Center , Cincinnati;Department of Pediatrics, College of Medicine , University of Cincinnati , Cincinnati;Division of Hospital Medicine, Department of Pediatrics , Cincinnati Children’s Hospital Medical Center , Cincinnati;Division of Pediatric Surgery , Cincinnati Children’s Hospital Medical Center , Cincinnati;Live Well Collaborative , College of Design, Architecture, Art, and Planning , Cincinnati;Division of Behavioral Medicine and Clinical Psychology , Cincinnati Children’s Hospital Medical Center , Cincinnati;Department of Orthopedics , Cincinnati Children’s Hospital Medical Center , Cincinnati

关键词: paediatrics;    pain;    patient-centred care;    focus groups;    surgery;   

DOI  :  10.1136/bmjoq-2022-001874

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Paediatric surgery is a stressful experience for patients and caregivers. While standardised protocols are the norm, patient-centred approaches are needed to empower patients/caregivers for an optimal perioperative pain experience. To address this gap, we employed a patient-centred approach using design thinking (DT) methodology to develop insights, map processes, identify opportunities and design solutions for individualised empowerment tools.Methods In consultation with DT experts, a multidisciplinary team of stakeholders (healthcare providers, patients who underwent pectus excavatum/scoliosis surgery and their caregivers), were invited to participate in surveys, interviews and focus groups. The project was conducted in two sequential stages each over 24 weeks—involving 7 families in stage 1 and 16 patients/17 caregivers in stage 2. Each stage consisted of three phases: design research (focus groups with key stakeholders to review and apply collective learnings, map processes, stressors, identify influencing factors and opportunities), concept ideation (benchmarking and co-creation of new solutions) and concept refinement.Results In stage 1, mapping of stress/anxiety peaks identified target intervention times. We identified positive and negative influencers as well as the need for consistent messaging from the healthcare team in our design research. Current educational tools were benchmarked, parent-child engagement dyads determined and healthcare-based technology-based solutions conceived. The ‘hero’s journey’ concept which has been applied to other illness paradigms for motivation successfully the was adapted to describe surgery as a transformative experience. In stage 2, patient and caregiver expectations, distinct personas and responses to perioperative experience were categorised. Educational tools and an empowerment tool kit based on sensorial, thinking, relaxation and activity themes, tailored to parent/child categories were conceptualised.Conclusion DT methodology provided novel family centred insights, enabling design of tailored empowerment toolkits to optimise perioperative experience. Adapting the hero’s journey call to adventure may motivate and build resilience among children undergoing surgery.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND