Predictors of parental management of children's pain after paediatric outpatient surgery

Relatively little is known about the factors that drive parents' use of pain management strategies after outpatient surgery. The present study employed the Health Belief Model (Rosenstock 1966; Becker & Rosenstock, 1984) as the primary model when formulating predictions of how parents' beliefs may influence their use of pain management strategies. Additional elements were added from the Theory of Reasoned Action (Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980, Fishbein, 1982), and the Theory of Planned Behaviour (Ajzen, 1985; Ajzen & Madden, 1986).; Children about to undergo outpatient surgery (N=125; 61% males; 5-12 years of age) and their caregivers were recruited over a 5-month period from the Presurgical Consultation and Assessment Clinic at McMaster Children's Hospital.; Children reported mild to moderate levels of pain during the first two postsurgical days. Parents reported administering an average of 3.25 doses of medication across both days and reported promoting cognitive-behavioural pain management strategies (primarily distraction, and, to a lesser degree, imagery and relaxation) on an average of 5.05 of the 8 time periods (measured 4 times a day across 2 days).; Parents' administration of medication was primarily driven by their perception of the intensity of their child's pain, accounting for 39% of the unique variance, based on sequential regression analyses. Parental beliefs about the preventability of pain and the risk of prescription medication provided additional predictive power, accounting for an extra 5% of the variance.; Parents' promotion of cognitive-behavioural (largely distraction) strategies was largely driven by their perception of the intensity of their child's pain, accounting for 24% of the unique variance. Parental beliefs about the preventability of pain and the effectiveness of these strategies improved prediction, accounting for an additional 5% of the variance.; What are the implications of these findings? Given that parents' perception of children's pain is a large part of what drives their use of pain management strategies, health care providers should train parents to accurately assess their children's pain prior to discharge, and preemptively address their concerns about the potential harmfulness of pediatric pain medications. Moreover, children would also benefit if their parents received some training in and encouragement to use non-distraction based cognitive behavioral pain management approaches.