038. Pain experts’ and healthcare professionals’ prioritisation and interpretation of multi-dimensional patient-reported pain data from children with Juvenile Idiopathic Arthritis

Abstract

Background: Patient self-report of pain is regarded as the gold standard of assessment. There is increased recognition of the importance of using electronic, real-time data capture with multi-dimensional methods for children who have chronic pain. Notable advantages of these approaches include reductions in recall bias and improved compliance and engagement. However, the utilisation of the outputs of these tools in paediatric rheumatology settings may be impeded by the uncertainty that exists about which pain facets should be prioritised in guiding pain management decisions. Aims: To determine which features of multidimensional pain information from individuals with Juvenile Idiopathic Arthritis (JIA) were viewed as most salient by pain experts and paediatric rheumatology healthcare professionals. Methods: Participants were recruited via online advertisements posted by their professional organisations. Two separate group workshops were hosted at an international conference on pain and a national conference on paediatric rheumatology. Participants were asked to rank order nine vignette scenarios from highest pain to lowest pain using real patient data collected with an electronic multidimensional pain assessment tool (My Pain Tracker). The pain components collected by the tool were developed by children and included pain intensity, severity, location, pain quality descriptors (including symbols such as fire and sharpness) and emotions. Participants were asked to explain their individual reasoning for their rankings of pain experiences aloud within workshops. Recordings were transcribed and analysed using content analysis. Results: Nineteen participants took part: nine paediatric pain experts and ten paediatric rheumatology healthcare professionals. The high prioritisation of pain intensity was apparent for pain experts whereas pain intensity and severity together were most salient for healthcare professionals. Differences between groups emerged in the prioritisation of specific pain location information. For pain experts, the number of sites affected was important. However, for rheumatology healthcare professionals, localised pain around specific joints and number of joints affected were seen as high priority. Spread of pain around a particular joint, for example (demonstrated by the extent of shading) was not important for pain experts. Descriptors of pain quality were generally high prioritisations. For both groups, pain labels and pain colour (in particular, red) were salient in their interpretations. For rheumatology professionals only, use of the fire symbol was significant. Other than this, symbol chosen was not important. For the majority of both groups, pain emotion was a high priority. Conclusions: From this study it appears that pain experts and rheumatology healthcare professionals extract and use different combinations of pain information to interpret pain reports. The next step of this work is to develop useful visualisation tools that will enhance clinicians’ ability to assess and manage pain effectively.