■儿童慢性疼痛是一个广泛的公共卫生问题。我们需要了解患有慢性疼痛的儿童及其家庭如何经历慢性疼痛及其管理。
■对患有慢性疼痛的儿童及其家庭的慢性疼痛的经历和看法进行元民族志研究,治疗和服务。我们调查了儿童及其家庭如何概念化和生活在慢性疼痛中;他们对健康和社会护理服务的看法和需求;以及他们将“好”疼痛管理概念化。
■与利益相关者,患者和公众参与设计的元人种学,搜索和抽样策略,分析和传播。审查策略:2022年9月对12个书目数据库进行全面搜索和补充搜索,以确定3个月至18岁患有慢性非癌性疼痛的儿童及其家人的定性研究。我们纳入了具有丰富解释性数据的研究;使用关键评估技能计划工具评估方法上的局限性;并提取,分析和综合研究结果。我们使用了建议评级评估,开发和评估-对来自定性研究审查的证据的信心,以评估对审查结果的信心。我们将发现与14项Cochrane治疗儿童慢性非癌性疼痛的有效性综述相结合。
■我们从182篇出版物中报道的170项符合条件的研究中综合了43项研究。研究有轻微(n=24)或中等(n=19)的方法学限制。建议评估的分级,开发和评估-对来自对审查结果的定性研究评估的证据的信心很高(n=22),中等(n=13)或非常低的置信度(n=1)。中度和重度慢性疼痛对家庭成员的健康有深远的不利影响,自主性和自我认同;家庭动态;育儿方式;友谊和社交;儿童教育和父母有偿就业。大多数儿童和家庭都在寻求治疗疼痛的生物医学方法。他们在寻求和接受卫生服务机构的支持以管理疼痛及其影响方面遇到了困难。因此,一些家庭反复访问卫生服务。Cochrane对干预效果和试验的评价没有衡量对儿童和家庭重要的一些结果。例如疼痛对家庭的影响和疼痛的解决。在考虑干预措施的工作方式时,评论主要忽略了生物心理社会方法。
■关于偏头痛/头痛等常见疼痛状况的数据有限,腹痛;一些罕见的情况;学习障碍和五岁以下儿童;兄弟姐妹;父亲和治疗/服务经验。我们排除了癌症研究,临终痛苦和医疗保健专业人员的经验。
■我们发展了以家庭为中心的儿童慢性疼痛管理理论,将健康和社会护理与社区支持相结合。
■未来的研究应该探索家庭的服务和治疗经验,包括阿片类药物,和社会护理服务;自闭症和学习障碍儿童的经历,5岁以下,有一些常见的疼痛情况。我们需要发展和测试以家庭为中心的干预措施和服务。
■这项研究注册为PROSPERO(CRD42019161455)和CochranePain,姑息治疗和支持治疗(623)。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR128671)资助,并在健康和社会护理提供研究中全文发表。12号17.有关更多奖项信息,请参阅NIHR资助和奖励网站。
持续3个月或更长时间的慢性疼痛影响英国至少8%的儿童。它给儿童生活的许多方面造成了困难,包括人际关系,学校出勤率和国家卫生服务的使用。在英国,治疗儿童慢性疼痛的专业服务很少,缺乏高质量的研究。我们的研究旨在找到并汇集有关慢性疼痛儿童及其家庭的经历和观点的现有研究。我们想知道他们是如何看待和忍受慢性疼痛的,以及他们对服务和治疗的看法和经验,以及他们想从他们那里获得什么。我们与患有慢性疼痛的儿童及其家人一起进行了这项研究,慈善机构,医疗保健专业人员和学术专家。他们帮助我们进行研究,并确保我们的发现与儿童相关,家庭和国家卫生服务。我们汇集了43项研究的数据,这些数据最好地回答了我们的问题。我们发现,中度和重度儿童的慢性疼痛没有得到很好的管理,影响到整个家庭,包括他们的关系和社交生活。家庭发现很难从卫生服务机构获得帮助和诊断。大多数家庭都想要治疗疼痛的药物。家庭等待答案和治疗很长时间,但逐渐意识到可能无法治愈,所以他们专注于痛苦地生活或放弃希望。来自少数民族群体或有学习障碍的儿童和家庭经历了歧视。很少有针对5岁以下儿童的研究,有学习障碍或有服务经历的儿童。家庭需要一种适合整个家庭需求的疼痛管理方法,涉及学校,社会护理和卫生服务。我们的发现可以改善治疗指南,培训健康和社会护理专业人员以及服务设计和治疗。
UNASSIGNED: Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management.
UNASSIGNED: To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as \'good\' pain management.
UNASSIGNED: Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies\' findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children\'s chronic non-cancer pain.
UNASSIGNED: We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members\' well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children\'s education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work.
UNASSIGNED: There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals.
UNASSIGNED: We developed the family-centred theory of children\'s chronic pain management, integrating health and social care with community support.
UNASSIGNED: Future research should explore families\' experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services.
UNASSIGNED: This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623).
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.
Chronic pain lasting 3 months or more affects at least 8% of children in the UK. It causes difficulties with many aspects of children’s lives including relationships, school attendance and use of National Health Services. In the UK, there are few specialist services and a lack of high-quality research for managing children’s chronic pain. Our study aimed to locate and pull together existing research on the experiences and views of children with chronic pain and their families. We wanted to find out how they think about and live with chronic pain, and their views and experiences of services and treatments, and what they want to achieve from them. We conducted this study alongside children with chronic pain and their families, charities, healthcare professionals and academic experts. They helped us to conduct the study and to ensure our findings are relevant to children, families and the National Health Service. We pulled together data from 43 studies that best answered our questions. We found that moderate and severe children’s chronic pain that was not well managed affected the whole family, including their relationships and social lives. Families found it difficult to get help and a diagnosis from health services. Most families wanted a medical cure for pain. Families had long waits for answers and treatment but gradually realised there may be no cure, so they focused on living well with pain or gave up hope. Children and families from ethnic minority groups or with a learning disability experienced discrimination. Few studies focused on children under 5 years old, children with learning disabilities or experiences of services. Families need a pain management approach tailored to the whole family’s needs involving schools, social care and health services. Our findings could improve treatment guidelines, training of health and social care professionals and service design and treatments.