title: Parents' Analgesic Trade-Off Dilemmas: How Analgesic Knowledge Influences Their Decisions to Give Opioids.
abstract: OBJECTIVE
  Ineffective analgesic decisions in the home may jeopardize the safety and comfort of children, yet little is known about factors influencing parental decisions. This study explored how parents' analgesic understanding influenced their hypothetical decisions to give opioids when faced with important trade-off dilemmas where pain and adverse drug event (ADE) symptoms were both present.
  
  
  METHODS
  A total of 514 parents whose children required opioids after discharge completed surveys assessing their Gist ADE Understanding (ie, knowledge of opioid-related ADEs and their seriousness) and other comparative analgesic perceptions. Parents then made hypothetical decisions to give or withhold prescribed opioids to a postoperative child with varying pain levels and serious (oversedation) and nonserious (nausea) ADE symptoms.
  
  
  RESULTS
  Gist ADE Understanding influenced decisions to withhold opioids for a child with nausea/vomiting (β=0.85 [95% confidence interval (CI), 0.74-0.98]) or oversedation (β=0.86 [95% CI, 0.77-0.97]), but not for one with no ADE (β=1.00 [95% CI, 0.98-1.02]). However, while perceived higher seriousness of oversedation influenced withholding opioids when this ADE was present (mean difference=0.36 [95% CI, 0.11-0.61], P=0.005), knowledge that oversedation was possible did not by itself affect behavior (odds ratio=0.80 [95% CI, 0.50-1.29], P=0.362).
  
  
  CONCLUSIONS
  These data suggest that gist understanding of ADE seriousness, not just its possible presence, is needed to facilitate safe analgesic decisions. Importantly, higher overall ADE understanding did not influence parents' opioid decisions in the presence of high pain and absence of ADEs. Thus, risk information about specific ADEs is unlikely to dissuade parents from efforts to manage pain but may improve their decisions if ADEs should occur.
authors.affiliation: *Department of Pediatric Anesthesiology, Mott Children's Hospital †Department of Health Behavior and Health Education, School of Public Health ‡Department of Internal Medicine §School of Nursing, University of Michigan, Ann Arbor, MI.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Smith
authors.forename: Richard W
authors.initials: RW
authors.lastname: Redman
authors.forename: Sarah
authors.initials: S
authors.lastname: Zyzanski
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D004522:Educational Status; D017558:Elective Surgical Procedures / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008824:Michigan; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D059408:Pain Management / Q000523:psychology / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D010290:Parents / Q000523:psychology*; D063046:Patient Medication Knowledge / Q000706:statistics & numerical data*; D017678:Sex Distribution
chemical_list: D000701:Analgesics, Opioid