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


METHODS
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).


CONCLUSIONS
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.
Columbia University School of Nursing, New York, New York.
Mary W
MW
Byrne
Department of Pediatrics, Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California.
Elana
E
Evan
Columbia University School of Nursing, New York, New York.
Lorie S
LS
Goshin
Department of Psychiatry and Psychiatric Education, New York State Psychiatric Institute, and Columbia University Medical Center, New York, New York.
Matthew D
MD
Erlich
Department of Pediatrics, Pediatric Pain Program, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California.
Jackie H J
JH
Kim
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.
John M
JM
Saroyan
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.
Lonnie K
LK
Zeltzer
D000293:Adolescent; D017028:Caregivers / Q000523:psychology*; D002648:Child; D016638:Critical Illness; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D019964:Mood Disorders / Q000209:etiology / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D010290:Parents / Q000523:psychology*; D020377:Self Efficacy; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*; D055815:Young Adult