Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses

Megan Greenough; Tracey Bucknall; Lindsay Jibb; Krystina Lewis; Christine Lamontagne; Janet Elaine Squires

doi:10.3389/fpain.2022.1001028

Attaining expert consensus on diagnostic expectations of primary chronic pain diagnoses for patients referred to interdisciplinary pediatric chronic pain programs: A delphi study with pediatric chronic pain physicians and advanced practice nurses

Front Pain Res (Lausanne). 2022 Sep 12:3:1001028. doi: 10.3389/fpain.2022.1001028. eCollection 2022.

Authors

Megan Greenough¹, Tracey Bucknall², Lindsay Jibb³, Krystina Lewis⁴, Christine Lamontagne⁵, Janet Elaine Squires⁶

Affiliations

¹ School of Nursing, Chronic Pain Services, The Children's Hospital of Eastern Ontario Chronic Pain Services at The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
² School of Nursing, Deakin University, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, VIC, Australia.
³ Bloomberg Faculty of Nursing, Pediatric Nursing Research, SickKids Hospital, University of Toronto, Toronto, ON, Canada.
⁴ School of Nursing, The University of Ottawa, Ottawa, ON, Canada.
⁵ Department of Medicine, Chronic Pain Services, The Children's Hospital of Eastern OntarioUniversity of Ottawa, Ottawa, ON, Canada.
⁶ School of Nursing, University Research Chair in Health Evidence Implementation, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Abstract

Objective: Pediatric primary chronic pain disorders come with diagnostic uncertainty, which may obscure diagnostic expectations for referring providers and the decision to accept or re-direct patients into interdisciplinary pediatric chronic pain programs based on diagnostic completeness. We aimed to attain expert consensus on diagnostic expectations for patients who are referred to interdisciplinary pediatric chronic pain programs with six common primary chronic pain diagnoses.

Method: We conducted a modified Delphi study with pediatric chronic pain physicians, nurse practitioners and clinical nurse specialists to determine degree of importance on significant clinical indicators and diagnostic items relevant to each of the six primary chronic pain diagnoses. Items were identified through point of care databases and complimentary literature and were rated by participants on a 5-point Likert scale. Our consensus threshold was set at 70%.

Results: Amongst 22 experts across 14 interdisciplinary programs in round one and 16 experts across 12 interdisciplinary programs in round two, consensus was reached on 84% of diagnostic items, where the highest degree of agreement was with Complex Regional Pain Syndrome (CRPS), Type 1 (100%) and the lowest with chronic pelvic pain (67%).

Conclusion: This study demonstrated a general agreement amongst pediatric chronic pain experts regarding diagnostic expectations of patients referred to interdisciplinary chronic pain programs with primary chronic pain diagnoses. Study findings may help to clarify referral expectations and the decision to accept or re-direct patients into such programs based on diagnostic completeness while reducing the occurrence of unnecessary diagnostic tests and subsequent delays in accessing specialized care.

Keywords: chronic pain; diagnostic investigations; interdisciplinary chronic pain program; pediatric; red flags; referral practices; significant clinical indicators.