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Parent self-efficacy for managing pain in seriously ill children and adolescents nearing end of life

Published online by Cambridge University Press:  04 May 2011

Mary W. Byrne ,
Elana Evan ,
Lorie S. Goshin ,
Matthew D. Erlich ,
Jackie H.J. Kim ,
John M. Saroyan  and
Lonnie K. Zeltzer
Mary W. Byrne*
Affiliation:
Columbia University School of Nursing, New York, New York
Elana Evan
Affiliation:
Department of Pediatrics, Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
Lorie S. Goshin
Affiliation:
Columbia University School of Nursing, New York, New York
Matthew D. Erlich
Affiliation:
Department of Psychiatry and Psychiatric Education, New York State Psychiatric Institute, and Columbia University Medical Center, New York, New York
Jackie H.J. Kim
Affiliation:
Department of Pediatrics, Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
John M. Saroyan
Affiliation:
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University and Division of Pediatric Pain Medicine, Symptom Management and Palliative Care, Columbia University Medical Center, New York, New York
Lonnie K. Zeltzer
Affiliation:
Departments of Pediatrics, Psychiatry and Biobehavioral Sciences, and Anesthesiology, and Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California
*
Address correspondence and reprint requests to: Mary W. Byrne, Columbia University School of Nursing, 617 West 168 Street, New York, NY 10032. E-mail: mwb4@columbia.edu
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Abstract

Objective:

Using data from a multi-site study of parent–child symptom reporting concordance, this secondary analysis explored the role of parent self-efficacy related to pain management for seriously ill school-age children and adolescents.

Method:

In the initial study, 50 children and adolescents who were expected to survive 3 years or less were recruited along with their parent/primary caregiver. Parent self-report data were used in this secondary analysis to describe parent self-efficacy for managing their child's pain, caregiver strain, mood states, and perception of the child's pain; to explore relationships among these variables; and to determine predictors of greater self-efficacy.

Results:

Parents expressed a wide range of self-efficacy levels (Chronic Pain Self-Efficacy Scale; possible range 10–100, mean 76.2, SD 14.7) and higher levels on average than reported previously by family caregivers of adult patients. Caregiver Strain Index scores were markedly high (possible range 0–13, mean 8.1, SD 3.8) and inversely correlated with self-efficacy (r = −0.44, p = 0.001). On the Profile of Mood States parents reported more negative moods (t = 4.0, p < 0.001) and less vigor (t = −5.0, p < 0.001) than adults in a normative sample, yet vigor rather than mood disturbance predicted self-efficacy. With the exception of child age, self-efficacy was not associated with demographics (child gender, ethnicity, household income, parent age, education, family size) or with the diagnostic groups (primarily cardiac and oncologic) comprising the sample. Younger child age, less caregiver strain, more parent vigor, and parent perception that child is without pain predicted more than half of the variance in parent self-efficacy (R2 = 0.51).

Significance of results:

Findings advance knowledge of parent self-efficacy in managing the pain of a child with life-threatening illness. Results can be used to design supportive interventions enhancing parents’ caregiving roles during their child's last stages of life.

Keywords

Self-efficacyPain managementSeriously ill childCaregiver strainParent mood
Type
Original Articles
Information
Palliative & Supportive Care , Volume 9 , Issue 2 , June 2011 , pp. 137 - 147
Copyright
Copyright © Cambridge University Press 2011

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