1
|
Racine N, Chow C, Hamwi L, Bucsea O, Cheng C, Du H, Fabrizi L, Jasim S, Johannsson L, Jones L, Laudiano-Dray MP, Meek J, Mistry N, Shah V, Stedman I, Wang X, Riddell RP. Health Care Professionals' and Parents' Perspectives on the Use of AI for Pain Monitoring in the Neonatal Intensive Care Unit: Multisite Qualitative Study. JMIR AI 2024; 3:e51535. [PMID: 38875686 PMCID: PMC11041412 DOI: 10.2196/51535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom. OBJECTIVE The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU. METHODS In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use. RESULTS The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it. CONCLUSIONS HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.
Collapse
Affiliation(s)
- Nicole Racine
- School of Psychology, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, ON, Canada
| | - Lojain Hamwi
- Department of Psychology, York University, Toronto, ON, Canada
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, ON, Canada
| | - Carol Cheng
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Hang Du
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Sara Jasim
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Neonatal Care Unit, University College London Hospitals, London, United Kingdom
| | - Neelum Mistry
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ian Stedman
- School of Public Policy and Administration, York University, Toronto, ON, Canada
| | - Xiaogang Wang
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | | |
Collapse
|
2
|
Zaffino JV, Shiff I, Stern AP, Flanders D, Weinberg E, Savlov D, Garfield H, Pillai Riddell R. Caregiver Ratings of Toddler Pain: The Role of Caregiver Psychological Predictors. J Pediatr Psychol 2023; 48:870-878. [PMID: 37776143 DOI: 10.1093/jpepsy/jsad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION/AIM Young children's limited ability to self-report pain necessitates an understanding of the factors that influence pain ratings. The current paper examines the relative prediction of caregiver psychological factors and toddler pain behaviors on caregiver pain ratings post-vaccination. METHODS One hundred fifty-six parent-toddler dyads were video recorded during pediatric vaccinations. Child pain behaviors were coded before, during, and after the needle using the Face, Legs, Activity, Cry, Consolability Scale and the Neonatal Facial Coding System). Caregivers rated their child's pain after the needle, reported pre- and post-needle worry during the visit, and completed rating scales assessing other areas of psychological functioning within 2 weeks after the appointment. Regression models were estimated to examine the relative contribution of child and caregiver factors to the prediction of caregiver pain ratings. RESULTS The regression model predicting caregiver pain ratings from the toddlers' pain-related distress (facial activity immediately after the needle, overall pain-related behavior immediately after, 1-min and 2-min post-needle) and caregiver worry were significant (adjusted R-square = 0.21), with caregiver pre- and post-needle worry being the only significant predictors of caregiver pain ratings. CONCLUSIONS This study outlines that although child distress behavior remains a significant influence on pain ratings during toddlerhood, when caregiver worry (pre- and post-needle) was entered into the model, they were the only significant predictors of caregiver pain ratings.
Collapse
Affiliation(s)
- Jessica V Zaffino
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Ilana Shiff
- Department of Psychology, York University, Toronto, ON, Canada
| | - Amy P Stern
- Department of Psychology, York University, Toronto, ON, Canada
| | | | | | | | - Hartley Garfield
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Rebecca Pillai Riddell
- Department of Psychology, York University, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
3
|
Badovinac SD, Flora DB, Edgell H, Flanders D, Garfield H, Weinberg E, Savlov D, Pillai Riddell RR. A Measure of Caregivers' Distress-Promoting Behaviors During Toddler Vaccination: Validation of the OUCHIE-RV. J Pediatr Psychol 2023; 48:787-797. [PMID: 37568248 PMCID: PMC10516456 DOI: 10.1093/jpepsy/jsad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE The current study discusses the development and preliminary validation of an observational measure of caregivers' distress-promoting behavior (OUCHIE-RV) in the context of toddler routine vaccination. METHODS Measure validation was based on a sample of caregiver-toddler dyads (N = 223) from a longitudinal cohort-sequential study who were observed during toddlers' 12-, 18-, or 24-month routine vaccinations. Validity was assessed using correlations and cross-lagged path analysis and associations were tested between OUCHIE-RV composite scores and toddlers' pain-related distress as well as caregivers' state anxiety, soothing behaviors, heart rate, and heart rate variability. Interrater reliability was examined using intraclass correlations (ICC) and kappa coefficients. RESULTS Results of a cross-lagged path analysis indicated positive concurrent (β = .27 to β = .37) and cross-lagged predictive associations (β = .01 to β = .34) between OUCHIE-RV composite scores (reflecting the frequency and intensity of caregivers' distress-promoting behavior) and toddlers' pain-related distress. OUCHIE-RV composite scores were negatively associated with caregivers' concurrent use of physical comfort (r = -.34 to -.24) and rocking (r = -.36 to -.19) and showed minimal associations with caregivers' use of verbal reassurance (r = .06 to .12), state anxiety (r = -.02 to r = .09), heart rate (r = -.15 to r = .05), and heart rate variability (r = -.04 to r = .13). Interrater reliability was strong (Cohen's k = .86 to .97, ICC = .77 to .85). CONCLUSIONS Findings provide support for the validity and reliability of the OUCHIE-RV as a research tool for measuring caregiver behaviors that promote toddlers' pain-related distress during routine vaccinations and contribute to a better understanding of the dynamics of caregiver-toddler interaction in acute pain contexts.
Collapse
Affiliation(s)
| | - David B Flora
- Department of Psychology, York University, Toronto, ON, Canada
| | - Heather Edgell
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | | | - Hartley Garfield
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Rebecca R Pillai Riddell
- Department of Psychology, York University, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
4
|
Badovinac SD, Chow C, Di Lorenzo-Klas MG, Edgell H, Flora DB, Riddell RRP. Parents' Physiological Reactivity to Child Distress and Associations with Parenting Behaviour: A Systematic Review. Neurosci Biobehav Rev 2023:105229. [PMID: 37196925 DOI: 10.1016/j.neubiorev.2023.105229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/01/2023] [Accepted: 05/07/2023] [Indexed: 05/19/2023]
Abstract
This systematic review and narrative synthesis characterized parents' physiological stress responses to child distress and how parents' physiological and behavioural responses relate. The review was pre-registered with PROSPERO (#CRD42021252852). In total, 3,607 unique records were identified through Medline, Embase, PsycINFO, and CINAHL. Fifty-five studies reported on parents' physiological stress responses during their young child's (0-3 years) distress and were included in the review. Results were synthesized based on the biological outcome and distress context used and risk of bias was evaluated. Most studies examined cortisol or heart rate variability (HRV). Small to moderate decreases in parents' cortisol levels from baseline to post-stressor were reported across studies. Studies of salivary alpha amylase, electrodermal activity, HRV, and other cardiac outcomes reflected weak or inconsistent physiological responses or a paucity of relevant studies. Among the studies that examined associations between parents' physiological and behavioural responses, stronger associations emerged for insensitive parenting behaviours and during dyadic frustration tasks. Risk of bias was a significant limitation across studies and recommendations for future research are discussed.
Collapse
Affiliation(s)
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, Canada
| | | | - Heather Edgell
- School of Kinesiology & Health Science, York University, Toronto, Canada
| | - David B Flora
- Department of Psychology, York University, Toronto, Canada
| | - Rebecca R Pillai Riddell
- Department of Psychology, York University, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada.
| |
Collapse
|
5
|
An introduction to the biennial review of pain. Pain 2022; 163:S1-S2. [DOI: 10.1097/j.pain.0000000000002774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|