title: Comfort First: an evaluation of a procedural pain management programme for children with cancer.
abstract: BACKGROUND
  The Comfort First Program (CFP) provides children and their caregivers with early procedural pain management intervention to reduce procedural pain and distress. This study evaluated whether the CFP was meeting its goals and effectively implementing the Royal Australasian College of Physicians paediatric pain management guidelines.
  
  
  METHODS
  The study was conducted as a single-site cross-sectional audit. One hundred and thirty-five patients (mean age 7.7 years) receiving treatment at the Royal Children's Hospital, Melbourne, Children's Cancer Centre Day Oncology Unit were observed. Procedural aspects related to the treatment room, carer and staff behaviour, child distress and use of pharmacologic and nonpharmacologic interventions were recorded using an audit tool developed for the study.
  
  
  RESULTS
  The procedure room was regularly quiet and prepared before the child entered. Median procedure duration was 8 min. Median procedure wait time was 54 min. At least one carer was typically present during procedures. Comfort First (CF) clinicians were more likely to be present in procedures with a significantly distressed child. Carers, nurses and CF clinicians generally displayed comfort-promoting behaviour. Topical anaesthetic was regularly utilised. Nonpharmacologic supports were frequently used, particularly distraction. Patients under 8 years of age were significantly more likely to receive nonpharmacologic supports and have a carer and CF clinician present. Age was a significant predictor of distress, with higher distress rates in younger children.
  
  
  CONCLUSIONS
  The CFP was found to be effectively implementing procedural pain guidelines. Regular audit is recommended to ensure adherence to pain management standards.
authors.affiliation: Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia. maria.mccarthy@rch.org.au
authors.forename: Maria
authors.initials: M
authors.lastname: McCarthy
authors.forename: Ron
authors.initials: R
authors.lastname: Glick
authors.forename: Jessica
authors.initials: J
authors.lastname: Green
authors.forename: Karin
authors.initials: K
authors.lastname: Plummer
authors.forename: Kari
authors.initials: K
authors.lastname: Peters
authors.forename: Lydia
authors.initials: L
authors.lastname: Johnsey
authors.forename: Cinzia
authors.initials: C
authors.lastname: Deluca
mesh_terms: D000293:Adolescent; D001315:Australia; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000175:diagnosis; D010146:Pain / Q000209:etiology* / Q000517:prevention & control* / Q000523:psychology; D059408:Pain Management / Q000592:standards* / Q000706:statistics & numerical data; D010147:Pain Measurement; D017410:Practice Guidelines as Topic