What Influences Canadian Pediatric Emergency Physicians When Prescribing Opioids for Children with Acute Pain?: A Qualitative Study

• Introduction: Pain is one of the most common symptoms requiring attention in the emergency department (ED), and opioids are amongst the top three medications used to treat pain in children. Recent pressures, including the ongoing Opioid Crisis, have compelled practitioners to consider the potential risk of misuse/addiction of opioids, and to balance this with the real consequences of undertreated pain. Understanding the reasoning behind physicians’ opioid prescribing practices is vital to safe practice, as they are one of the main gatekeepers (along with parents) to optimal acute pain management in children. The primary objective of our study was to describe the pediatric emergency physicians’ decision-making process when prescribing opioids for acute pain management. • Methods: This study employed a qualitative methodology, using one-on-one semi-structured interviews within a grounded theory analytic framework. We used purposeful sampling to recruit pediatric emergency physicians practicing at pediatric tertiary care centers across Canada with a minimum of 1-year clinical experience. Our exclusion criteria included physicians not currently licensed to practice pediatric emergency medicine and lack of proficiency in spoken English. Interviews were conducted over telephone by a qualitative methods-trained interviewer. Transcript analysis occurred concurrently with data collection, allowing for considerations around data saturation and theory development. • Results: A total of 11 interviews were completed. Participants represented the Canadian geographic regional distribution: Eastern, Central, and Western Canada. Interviews revealed nine major themes: 1) Treatment setting, 2) Medical considerations, 3) Physician confidence in the evidence, 4) Pain assessment, 5) Family-specific considerations, 6) Safety concerns, 7) Physician personal experiences, 8) Physician professional context, and 9) The Opioid Crisis and media influence. All participants identified challenges managing acute pain presentations in the ED, emphasizing the need for better guidance, evidence-based data, and knowledge translation. A family-centered approach was recognized as the current gold-standard of practice, especially in the midst of the current Opioid Crisis. However, after considering all other factors, most physicians indicated that the Opioid Crisis had minimal impact on their analgesic decision-making final outcomes. Suggestions for the future included addressing emerging challenges such as the management of opioid dependency and withdrawal in the pediatric setting. • Conclusion: Our study explored the decision-making process for managing acute pain, isolating significant barriers, facilitators, and considerations when pediatric emergency physicians prescribe opioids. This can help inform knowledge translation strategies for safer practice and optimize acute pain management in pediatrics.