Trauma-Informed Procedural Pain Intervention: Refining a Piloted Intervention for Improved Feasibility and Acceptability (TIPPI-R)

1 Trauma-Informed Procedural Pain Intervention: Refinement of an Evidence-Based Protocol for Pain- Associated with Oncology Treatment (TIPPI-R) Abstract Treatment for pediatric cancer requires painful medical procedures, such as lumbar punctures, and often involves painful side effects, including mucositis and neuropathy (Tutelman et al., 2018). Uncontrolled pain during cancer treatment is associated with poor physical and mental health outcomes for children and their families (Uhl et al., 2020). Specifically, given the frequency and intensity of painful procedures for children diagnosed with cancer, these children and their families are at an elevated risk for medical traumatic stress compared with families of children diagnosed with other illnesses (Price et al., 2016). A Trauma-Informed Care (TIC) approach provides a foundation for minimizing trauma exposure for families within the medical setting and recognizing trauma symptoms to address with intervention (SAMHSA, 2015). To facilitate family coping with traumatic experiences in pediatric cancer treatment, there is a critical need for trauma-informed and family-centered behavioral interventions for pediatric cancer-related pain (Uhl et al., 2020). The Trauma-Informed Procedural Pain Intervention (TIPPI) is designed as an evidence-based treatment protocol to facilitate enhanced pain management strategies. Using a trauma-informed approach, TIPPI provides psychoeducation about behavioral responses to pain, as well as behavioral pain management strategies. In addition, TIPPI empowers families to advocate for practices that will help reduce their child’s distress and discomfort and to teach their child adaptive pain-coping strategies. Preliminary testing (n = 8 suggests) support for early feasibility in that TIPPI can delivered in a variety of contexts (e.g., inpatient, outpatient), at various points of cancer treatment (e.g., new diagnosis, 6 months post-diagnosis), and that TIPPI can assist with pain related to a range of aspects of treatment (e.g., procedural distress, medication- induced side effects). In our ongoing pilot study, we have successfully enrolled 87.5% of eligible families and completed TIPPI with 100% of consented families, which suggests preliminary acceptability of the intervention. Thus, proof-of concept for TIPPI has been piloted successfully and is ready for additional testing.