Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the “Children’s Comfort Promise”, includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs).Methods: A QI pilot project utilizing the Model for Improvement of the “Global Comfort Promise” was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children’s Research Hospital, and adopted, adapted, and implemented the project at their individual sites.Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child’s pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative.Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.
引言：癌症患儿在针基操作过程中常经历显著的疼痛与焦虑。儿童疼痛若未得到充分处理，将产生长期不良后果并降低后续镇痛措施的效果。一项经验证的质量改进干预措施——“儿童舒适承诺”，包含(1)局部麻醉剂使用、(2)婴儿蔗糖水喂养或母乳喂养、(3)舒适体位安置及(4)注意力分散技术，已被证实能有效降低儿童操作相关疼痛与焦虑。然而，关于中低收入国家采纳、调整和实施此类干预措施的数据仍较为有限。 方法：本研究采用“全球舒适承诺”改进模型，在四家国际儿科肿瘤医院（秘鲁利马、巴西巴雷图斯、南非彼得马里茨堡、菲律宾马尼拉）开展质量改进试点项目。2021年8月至2023年1月期间，各试点中心与圣裘德儿童研究医院共同制定具体目标、设计测量策略，并在各自机构内采纳、调整并实施该项目。 结果：实施首年共记录2,185例次操作。多数患者年龄小于10岁（60.5%），实体瘤（37.9%）为最常见诊断。总体而言，医护人员对操作过程的满意度达98.3%。家长与患儿反馈显示仅33.7%患儿在操作过程中感到疼痛。所有（100%）家长和患儿均认为医疗团队充分关注了患儿的疼痛问题。医护人员自报采用≥2项干预措施的中位依从率达98.0%。项目实施面临的挑战包括培训不足、医务人员流动、维持团队积极性及局部麻醉剂获取困难。各试点中心均制定了独特的改进方案以推动项目实施。 结论：这项多中心、跨国质量改进项目具有可行性，在中低收入国家环境下成功实现采纳、调整与实施，有效改善了儿童操作疼痛问题（全球舒适承诺）。该干预措施同时获得了医护人员及患者/家属的高度满意。未来需着力解决局部麻醉剂获取与医务人员培训等挑战。后续计划将优化全球舒适承诺方案，纳入高质量医患沟通内容，并通过完善实施策略推广至更多医疗中心。
肿瘤(癌症)患者之家