PEDIATRIC OPIOID ANALGESIA SELF-INSTRUCTION SYSTEM (PEDOASIS): AN EFFECTIVE EDUCATION TOOL

ABSTRACT

Background: Many children with cancer, survivors of childhood cancer, and patients with sickle cell disease experience pain, yet receive inadequate pain management due to health care provider lack of knowledge and comfort. Pain management using opioids is a required competency for pediatric hematology/oncology (PHO) fellows, yet knowledge gaps persist. Objectives: Pediatric Opioid Analgesia Self-Instruction System (PedOASIS) is an interactive, case-based education tool for independent learning by post-graduate medical trainees which has undergone pilot testing and validity and reliability testing. The goal of this study was to evaluate its efficacy in increasing PHO fellows' knowledge and comfort with using opioids to manage pain. Design/Method: PHO fellows were recruited from 74 ACGMEaccredited US programs during the 2019-2020 academic year. Participants were randomized to receive access to PedOASIS (intervention) or usual PHO training (control). Participants completed surveys at enrollment, immediately after distribution of the tool, and 6 months later. Surveys assessed subjective comfort with prescribing opioids and objective knowledge, using a version of the questions from the tool. Results: At baseline, mean scores on the 10-question knowledge assessment did not significantly differ by level of training (first year 5.05, second year 5.74, third/fourth year 5.58;p = 0.410) or between groups (intervention 5.38, control 5.5;p = 0.795). Following intervention, mean score was significantly higher in the intervention group (8.91) vs. controls (5.38;p < .0001). Six months later, scores in both groups decreased but remained significantly higher in the intervention group (6.91) compared to baseline (p = 0.0002) and compared to controls (4.91, p < .0001). Fellows indicated comfort with selecting opioid and starting dose for an opioid-naive patient at baseline but less with rotating opioids. Intervention group reported significant increases in comfort dosing opioids after exposure to the tool (p = 0.022) and in rotating opioids (p = 0.054) following the intervention. Conclusion: Use of PedOASIS was associated with improvement in scores on validated knowledge questions and in comfort using opioids for pain management in PHO fellows exposed to the tool compared to fellows without the tool. These findings suggest that this is a valid, reliable, and effective curricular tool. The use of self-directed learning has been associated with increased knowledge gains when compared to traditional didactic methods. The asynchronous learning structure is useful in the setting of the ongoing SARS-CoV19 pandemic, which has necessitated significant alterations in medical education. Based on these results, we suggest that PedOASIS is an effective and relevant addition to the PHO fellowship curriculum.