Why are children still crying? Going beyond “evidence” in guideline development to improve pain care for children: the HELPinKIDS experience

Abstract The failure to translate research evidence into day-to-day clinical practices is identified as a significant reason for suboptimal quality care across the health system, including procedural pain management in children. Clinical practice guidelines (CPGs) have been developed to assist in this process by synthesizing and interpreting research evidence for end users. Numerous CPGs have been developed for procedural pain management in children, yet gaps persist in the adoption of best practices. This article reviews the experience and approach of 1 guideline development group, the Help ELiminate Pain in KIDS Team (HELPinKIDS), in incorporating implementation considerations and knowledge translation (KT) strategies within the process of guideline development for the HELPinKIDS CPG about childhood vaccination pain management to facilitate greater uptake of the CPG. Specific areas that will be addressed include partnerships with stakeholders, rigor of guideline development, issues of implementation, and editorial independence. The work of HELPinKIDS was guided by a KT map, which identified, at a high level, the target audiences, key messages, tools, and strategies that could be used to communicate, disseminate, and implement the CPG into diverse settings. Examples of impact at both the individual and systems levels from HELPinKIDS KT activities are also presented.

[1]  Andrew F. Ilersich,et al.  Impact of parent-directed education on parental use of pain treatments during routine infant vaccinations: a cluster randomized trial , 2015, Pain.

[2]  Matt K. Sheedy,et al.  Impact of prenatal education on maternal utilization of analgesic interventions at future infant vaccinations: A cluster randomized trial , 2014, PAIN®.

[3]  B. Stevens,et al.  Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review , 2014, Pediatrics.

[4]  N. MacDonald,et al.  Impact of a Parent-Directed Pamphlet About Pain Management During Infant Vaccinations on Maternal Knowledge and Behavior , 2014, Neonatal Network.

[5]  Romina Brignardello-Petersen,et al.  Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise , 2014, Canadian Medical Association Journal.

[6]  Elke Hausner,et al.  Appraisal Tools for Clinical Practice Guidelines: A Systematic Review , 2013, PloS one.

[7]  A. Taddio,et al.  Implementation of a new clinical practice guideline regarding pain management during childhood vaccine injections. , 2013, Paediatrics & child health.

[8]  Gordon Guyatt,et al.  Creating clinical practice guidelines: problems and solutions. , 2013, Chest.

[9]  E. Manias,et al.  Pain management strategies used during early childhood immunisation in Victoria , 2013, Journal of paediatrics and child health.

[10]  L. Franck,et al.  Knowledge translation of the HELPinKIDS clinical practice guideline for managing childhood vaccination pain: usability and knowledge uptake of educational materials directed to new parents , 2013, BMC Pediatrics.

[11]  M. Brouwers,et al.  Integrating guideline development and implementation: analysis of guideline development manual instructions for generating implementation advice , 2012, Implementation Science.

[12]  P. Shekelle,et al.  Developing clinical practice guidelines: target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest , 2012, Implementation Science.

[13]  P. Shekelle,et al.  Developing clinical practice guidelines: reviewing, reporting, and publishing guidelines; updating guidelines; and the emerging issues of enhancing guideline implementability and accounting for comorbid conditions in guideline development , 2012, Implementation Science.

[14]  J. Grimshaw,et al.  Knowledge translation of research findings , 2012, Implementation Science.

[15]  J. Grimshaw,et al.  Understanding the relationship between the perceived characteristics of clinical practice guidelines and their uptake: protocol for a realist review , 2011, Implementation science : IS.

[16]  Melanie Barwick,et al.  Epidemiology and management of painful procedures in children in Canadian hospitals , 2011, Canadian Medical Association Journal.

[17]  Louise Lemieux-Charles,et al.  How can we improve guideline use? A conceptual framework of implementability , 2011, Implementation science : IS.

[18]  C. Chambers,et al.  Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline , 2010, Canadian Medical Association Journal.

[19]  Pablo Alonso-Coello,et al.  The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies , 2010, Quality and Safety in Health Care.

[20]  Gene Feder,et al.  AGREE II: advancing guideline development, reporting and evaluation in health care. , 2010, Journal of clinical epidemiology.

[21]  F. Cluzeau,et al.  Development of the AGREE II, part 2: assessment of validity of items and tools to support application , 2010, Canadian Medical Association Journal.

[22]  France Légaré,et al.  Adapting clinical practice guidelines to local context and assessing barriers to their use , 2010, Canadian Medical Association Journal.

[23]  S. Straus,et al.  Defining knowledge translation , 2009, Canadian Medical Association Journal.

[24]  L. Green,et al.  Diffusion Theory and Knowledge Dissemination, Utilization, and Integration in Public Health , 2009, Annual review of public health.

[25]  D. Angus,et al.  Epidemiology and treatment of painful procedures in neonates in intensive care units. , 2008, JAMA.

[26]  L. Hillier,et al.  Sustainable Practice Improvements: Impact of the Comprehensive Advanced Palliative Care Education (CAPCE) Program , 2007, Journal of palliative care.

[27]  Nancy Donaldson,et al.  Evaluating the impact of partnerships to improve clinical quality. , 2007, Joint Commission journal on quality and patient safety.

[28]  A. Taddio,et al.  Routine Immunization Practices: Use of Topical Anesthetics and Oral Analgesics , 2007, Pediatrics.

[29]  S. Straus,et al.  Lost in knowledge translation: Time for a map? , 2006, The Journal of continuing education in the health professions.

[30]  Richard N. Shiffman,et al.  Bmc Medical Informatics and Decision Making the Guideline Implementability Appraisal (glia): Development of an Instrument to Identify Obstacles to Guideline Implementation , 2022 .

[31]  J. Grimshaw,et al.  Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. , 2005, Journal of clinical epidemiology.

[32]  J M Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2004, International Journal of Technology Assessment in Health Care.

[33]  R. Grol,et al.  Clinical practice guidelines: towards better quality guidelines and increased international collaboration , 2003, British Journal of Cancer.

[34]  R. Grol.  Successes and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice , 2001, Medical care.

[35]  M Eccles,et al.  Why does primary care need more implementation research? , 2001, Family practice.

[36]  E. Balas,et al.  Managing Clinical Knowledge for Health Care Improvement , 2000, Yearbook of Medical Informatics.

[37]  E. McGlynn,et al.  How good is the quality of health care in the United States? , 1998, The Milbank quarterly.

[38]  A. Twycross.  Perceptions about children's pain experience. , 1998, Professional nurse.

[39]  M. Cousins.  International association for the study of pain , 1989, Pain.

[40]  Andrew F. Ilersich,et al.  From the mouth of babes: Getting vaccinated doesn’t have to hurt , 2014, The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale.

[41]  Sharon E Straus,et al.  Knowledge translation is the use of knowledge in health care decision making. , 2011, Journal of clinical epidemiology.

[42]  A. Taddio,et al.  La prise en charge de la douleur pendant la vaccination: les recommandations tirées de directives canadiennes de pratique clinique , 2011 .

[43]  A. Taddio,et al.  Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: systematic review of randomized controlled trials and quasi-randomized controlled trials. , 2009, Clinical therapeutics.

[44]  Christine T Chambers,et al.  Psychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review. , 2009, Clinical therapeutics.

[45]  M. Rieder,et al.  Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: systematic review and meta-analyses. , 2009, Clinical therapeutics.

[46]  C. Chambers,et al.  Inadequate pain management during routine childhood immunizations: the nerve of it. , 2009, Clinical therapeutics.