Caregiver Perception of Procedural Pain and Health Care Provider Empathy During Pediatric Laceration Repair in the Emergency Department

OBJECTIVES: Pediatric laceration repair is a common and distressing emergency department (ED) procedure. Health care provider (HCP) empathy is considered central to family-centered care and perception of HCP empathy is linked to care outcomes, yet perception of HCP empathy surrounding pediatric ED procedures is understudied. We aimed to characterize caregiver perception of HCP empathy following pediatric laceration repair and examine associations with demographics, treatment factors, and procedural pain. METHODS: This cross-sectional study included a convenience sample of child-caregiver dyads (children 2 to 12 y) undergoing ED laceration repair. Children requiring inpatient admission, with developmental disability, or pain-related chronic illness were excluded. After the procedure, caregivers completed the Jefferson Scale of Patient Perceptions of Physician Empathy (range: 5 to 35). Child procedural pain was assessed via caregiver proxy report (Numeric Rating Scale) and researcher observation (Face, Legs, Activity, Cry, Consolability). HCPs self-reported demographics. We performed correlational and mean difference tests to examine associations between variables and caregiver-perceived HCP empathy. RESULTS: The sample included 176 child-caregiver dyads (60% enrollment rate). Mean caregiver-perceived HCP empathy was 28.25±6.10 (range: 5 to 35). Only one empathy item ("understanding doctor") was strongly endorsed by most caregivers (58.8%). Caregiver-reported child procedural pain, but not researcher-observed pain, was negatively associated with perceived HCP empathy (r=-0.18, P=0.03). At the item-level, caregiver-reported child pain was significantly lower when caregivers strongly agreed with 4 of the 5 empathy items (Z's 2.26 to 3.05, P<0.05). Researcher-assessed pain, demographic, or treatment factors (midazolam, length of stay, laceration length) were not associated with perceived HCP empathy (all P>0.05). CONCLUSION: Modest endorsement across empathy items highlight opportunities to enhance empathic, family-centered care surrounding pediatric ED procedures. Caregiver appraisal of child's pain was the only variable associated with perceived HCP empathy. Strategies targeting empathic pain-related communication may improve families' experiences and perception of care in the pediatric ED.