"I didn't know it was an option": Exploring caregivers' knowledge of available pain management strategies in the paediatric emergency department.

Objectives: Caregivers, children, and healthcare professionals (HCPs) should engage in shared decision-making (SDM) regarding a child's pain and comfort care plan in the emergency department (ED). A better understanding of caregivers' current knowledge and gaps regarding pain and comfort care in the ED could inform conversations to support such SDM. Methods: This was a single-centre, cross-sectional survey with 341 participants recruited from April to July 2022. Survey questions included demographics, current knowledge and perceived gaps, as well as comfort (rated with a 4-point Likert scale) in advocating for pain management strategies. Results: A total of 345 caregivers responded to the survey; 77.7% (265/341) were mothers, and 84.6% (286/338) spoke English at home. About 45.6% (113/248) knew that children could receive pain medication at triage, and 42.3% (105/248) knew that children could receive numbing cream before a skin-breaking procedure; 42.7% (106/248) knew about the availability of food/drink. Participants reported similar mean (SD) comfort asking for pharmacologic [3.0 (0.9)] and non-pharmacologic [2.9 (1.0)] pain management strategies. Qualitative feedback from caregivers demonstrated SDM could be best achieved through having knowledge mobilization tools readily available and improved approachability of HCPs. Conclusions: While caregivers generally report feeling comfortable advocating for pain and comfort care for their children, many lacked knowledge of available options. Better educating caregivers in pain and comfort care options can support their agency to advocate for better care plans for their children.