Funding outcome

Objectives: Parents are often the gatekeepers to the pharmacologic management of their children's pain. Concerns and preferences regarding medications, including opioids, influence their choices. Our primary objective was to explore and understand parental decision-making as it relates to acute pain management for their children presenting to the emergency department. Study Design: This study employed one-on-one semi-structured interviews. Parents of children with acute musculoskeletal injuries were recruited from 3 Canadian pediatric emergency departments. Interviews were conducted via telephone from June 2019 to March 2021. Verbatim transcription and thematic analyses occurred concurrently with data collection, supporting data saturation and theory development considerations. Results: Twenty-seven interviews were completed. Five major themes regarding pain care emerged: a) My child's comfort is a priority; b) Every situation is unique; c) Opioids only if necessary; d) Considerations when choosing opioids; and e) Pain research is important. Overall, parents were highly comfortable with their assessment of their child's pain. Participants' willingness to use opioid analgesia for their children was primarily dependent on perceptions of injury and pain severity. Opioid-averse and opioid-accepting families had similar considerations when making analgesic decisions but weighed risks and benefits differently. Conclusions: Parents assess and manage their children's pain globally and multi- modally, with comfort being prioritized. For most parents, the desire to relieve their children's pain outweighed concerns of substance use disorder, misuse, and adverse events when making decisions about opioid analgesia for short-term use. These results can inform evidence-based family-centered approaches to co-decision-making of analgesic plans for children with acute pain.