The Effectiveness of a Multifaceted Knowledge Translation Intervention on Pain in Hospitalized Infants

NCT ID: NCT03825822

Last Updated: 2023-11-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

21 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-05

Study Completion Date

2023-07-04

Brief Summary

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Hospitalized infants undergo multiple painful procedures daily. Despite generation of a significant amount of evidence, procedural pain assessment and management in infants continues to be suboptimal. Untreated pain at this vital developmental juncture is associated with negative behavioural and neurodevelopmental consequences. To address this knowledge to practice gap, the investigators developed the Implementation of Infant Pain Practice Change (ImPaC) Resource (Resource) to guide change in health care professionals' pain practice behaviour.

The aim of this study is (i) to evaluate the clinical effectiveness of the Resource (primary), (ii) to evaluate the implementation effectiveness of the Resource (secondary), and (iii) to explore how organizational context influences clinical and implementation outcomes (other).

Eighteen Level 2 or Level 3 Neonatal Intensive Care Units (NICUs) with a minimum of 15 beds across Canada will be included in a cluster randomized controlled trial (RCT). The NICUs will be randomized following baseline data collection using a computer-generated random allocation sequence (randomize.net) to either the intervention (INT) or standard practice (SP) arms. Those in INT arm will receive the Resource for a 6-month period. NICUs in the SP arm will continue as usual with their unit or institutional pain practices. They will be offered the Resource following outcomes assessment. Clinical outcomes will be assessed six months after randomization. Primary clinical outcomes include (1) the proportion of infants in the NICU who have procedural pain assessed with a valid pain measure, (2) the proportion of infants in the NICU who have procedural pain managed with an evidence-based pharmacological or physical intervention, and (3) the total number of painful procedures per infant in the NICU. Implementation outcomes will include feasibility, fidelity, cost, and reach. Organizational context will be assessed by using the Alberta Context Tool.

Detailed Description

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Conditions

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Pain Infant

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors
Blinding will only be possible for the data analysts because no identifiable information about the sites, including the infants in the NICUs, will be available in the database or data extracted from the database. The code associating units with the data will be securely stored by the lead site, kept separate from the data, and only made available to the lead site Research Team for analyses purposes.

Study Groups

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ImPaC Resource Intervention (INT)

The INT arm will receive the 7-step web-based ImPaC intervention to use over 6 months. The intervention is divided into the Plan Stage and the Change Stage. The Plan Stage (steps 1-4) is expected to be completed in 1 month. The Change Stage (steps 5-7) is expected to be completed in 1-2 months. We anticipate that Change Teams will be able to complete 2 cycles of change over the 6-month intervention period.

Group Type EXPERIMENTAL

ImPaC Resource Intervention (INT)

Intervention Type BEHAVIORAL

A Change Team will lead the implementation process of the ImPaC Resource using the steps:

Step 1: Complete a checklist to ensure its members can commit to responsibilities.

Step 2: Reflect on the unit's readiness for change.

Step 3: Perform an audit on 10 to 15 medical charts.

Step 4: Identify a practice change based on audit results (pain assessment or pain treatment). Develop an aim statement for the practice change.

Step 5: Select the KT strategies and plan the implementation.

Step 6: Perform an audit on 10 to 15 medical charts.

Step 7: Examine the effectiveness of the implementation and decide on the aim and KT strategies for the next cycle of change.

Standard Practice (SP)

The SP arm will continue as usual with their unit or institutional standard pain practices and any strategies that they would normally use to improve them (e.g. new staff orientation).

Group Type OTHER

Standard Practice (SP)

Intervention Type OTHER

The SP arm will continue as usual with their standard pain practices and will be offered the intervention 6 months after randomization and completion of data collection.

Interventions

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ImPaC Resource Intervention (INT)

A Change Team will lead the implementation process of the ImPaC Resource using the steps:

Step 1: Complete a checklist to ensure its members can commit to responsibilities.

Step 2: Reflect on the unit's readiness for change.

Step 3: Perform an audit on 10 to 15 medical charts.

Step 4: Identify a practice change based on audit results (pain assessment or pain treatment). Develop an aim statement for the practice change.

Step 5: Select the KT strategies and plan the implementation.

Step 6: Perform an audit on 10 to 15 medical charts.

Step 7: Examine the effectiveness of the implementation and decide on the aim and KT strategies for the next cycle of change.

Intervention Type BEHAVIORAL

Standard Practice (SP)

The SP arm will continue as usual with their standard pain practices and will be offered the intervention 6 months after randomization and completion of data collection.

Intervention Type OTHER

Eligibility Criteria

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Exclusion Criteria

* infant leaves the unit at any time (transfer, surgeries, procedures) during the designated 24h period for chart review,
* parents request to opt out of the study.

Staff members of the NICU will be eligible to participate on the ImPaC change team if they:

* are a health care professional,
* are English speaking,
* have 3+ years of experience in the NICU,
* have flexibility within their role to engage in the study, and

Staff members of the NICU will be invited to complete the organizational context survey if they:

* have 6 months experience in the NICU, and
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

The Hospital for Sick Children

OTHER

Sponsor Role lead

Responsible Party

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Bonnie Stevens

Senior Scientist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Bonnie Stevens, PhD

Role: PRINCIPAL_INVESTIGATOR

The Hospital for Sick Children

Locations

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The Hospital for Sick Children

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Brooke, J. (2013). SUS: A Retrospective. Journal of Usability Studies, 8(2), 29-40. https://doi.org/10.1074/jbc.R115.675280

Reference Type BACKGROUND

Brooke, J. (1996). SUS - A quick and dirty usability scale. Usability Evaluation in Industry, 189(194), 4-7. https://doi.org/10.1002/hbm.20701

Reference Type BACKGROUND

Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: A systematic review of observational studies. Eur J Pain. 2016 Apr;20(4):489-98. doi: 10.1002/ejp.757. Epub 2015 Jul 29.

Reference Type BACKGROUND
PMID: 26223408 (View on PubMed)

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. doi: 10.1186/1748-5908-4-50.

Reference Type BACKGROUND
PMID: 19664226 (View on PubMed)

Estabrooks CA, Squires JE, Cummings GG, Birdsell JM, Norton PG. Development and assessment of the Alberta Context Tool. BMC Health Serv Res. 2009 Dec 15;9:234. doi: 10.1186/1472-6963-9-234.

Reference Type BACKGROUND
PMID: 20003531 (View on PubMed)

Forman, J., & Damschroder, L. (2007). Qualitative Content Analysis (pp. 39-62). https://doi.org/10.1016/S1479-3709(07)11003-7

Reference Type BACKGROUND

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377-81. doi: 10.1016/j.jbi.2008.08.010. Epub 2008 Sep 30.

Reference Type BACKGROUND
PMID: 18929686 (View on PubMed)

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005 Nov;15(9):1277-88. doi: 10.1177/1049732305276687.

Reference Type BACKGROUND
PMID: 16204405 (View on PubMed)

Landsverk, J., Brown, C. H., Smith, J. D., Chamberlain, P., Curran, G. M., Palinkas, L., … McCue Horwitz, S. (2018). Design and Analysis in Dissemination and Implementation Research. In: Lewis, C. C., Proctor, E. K., & Brownson, R. C. (Eds.). Measurement Issues in Dissemination and Implementation Research (pp.201-227). Oxford University Press.

Reference Type BACKGROUND

Mayring, P. (2014). Qualitative Content Analysis Theoretical Foundation, Basic Procedures and Software Solution. Retrieved from http://nbn-resolving.de/urn:nbn:de:0168-ssoar-395173

Reference Type BACKGROUND

Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011 Mar;38(2):65-76. doi: 10.1007/s10488-010-0319-7.

Reference Type BACKGROUND
PMID: 20957426 (View on PubMed)

Squires, J. E., Hutchinson, A., Hayduk, L., Cranley, L. A., Cummings, G., Norton, P. G., & Estabrooks, C. A. (2014). Alberta Context Tool User Manual 2014.

Reference Type BACKGROUND

Stevens BJ, Yamada J, Estabrooks CA, Stinson J, Campbell F, Scott SD, Cummings G; CIHR Team in Children's Pain. Pain in hospitalized children: Effect of a multidimensional knowledge translation strategy on pain process and clinical outcomes. Pain. 2014 Jan;155(1):60-68. doi: 10.1016/j.pain.2013.09.007. Epub 2013 Sep 8.

Reference Type BACKGROUND
PMID: 24021861 (View on PubMed)

Stevens BJ, Yamada J, Promislow S, Stinson J, Harrison D, Victor JC; Members of the CIHR Team in Children's Pain. Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children. Implement Sci. 2014 Nov 25;9:120. doi: 10.1186/s13012-014-0120-1.

Reference Type BACKGROUND
PMID: 25928349 (View on PubMed)

Tariman JD, Berry DL, Halpenny B, Wolpin S, Schepp K. Validation and testing of the Acceptability E-scale for web-based patient-reported outcomes in cancer care. Appl Nurs Res. 2011 Feb;24(1):53-8. doi: 10.1016/j.apnr.2009.04.003. Epub 2009 Sep 18.

Reference Type BACKGROUND
PMID: 20974066 (View on PubMed)

Stevens B, Bueno M, Barwick M, Campbell-Yeo M, Chambers C, Estabrooks C, Flynn R, Gibbins S, Harrison D, Isaranuwatchai W, LeMay S, Noel M, Stinson J, Synnes A, Victor C, Yamada J. The implementation of infant pain practice change resource to improve infant procedural pain practices: a hybrid type 1 effectiveness-implementation study. Pain. 2024 Dec 6;166(7):1587-1596. doi: 10.1097/j.pain.0000000000003496.

Reference Type DERIVED
PMID: 39679622 (View on PubMed)

Bueno M, Stevens B, Barwick MA, Riahi S, Li SA, Lanese A, Willan AR, Synnes A, Estabrooks CA, Chambers CT, Harrison D, Yamada J, Stinson J, Campbell-Yeo M, Noel M, Gibbins S, LeMay S, Isaranuwatchai W. A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol. Trials. 2020 Jan 6;21(1):16. doi: 10.1186/s13063-019-3782-9.

Reference Type DERIVED
PMID: 31907017 (View on PubMed)

Other Identifiers

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REB1000061599

Identifier Type: -

Identifier Source: org_study_id

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