Impact of Individualized Versus Weight-Based Pain Protocols on Patient Satisfaction for Patients With Sickle Cell Disease Experiencing a Vaso-Occlusive Episode.
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2025-07
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Abstract
Introduction
National guidelines for the acute management of sickle cell disease vaso-occlusive episodes recommend the use of a patient-specific or a weight-based protocol. The authors compared patient satisfaction with pain management between those randomized to receive either a patient-specific or weight-based pain protocol in the COMPARE-VOE randomized control trial.Methods
Participants with sickle cell disease were pre-enrolled and patient satisfaction with pain management was assessed at the time of discharge from the 6 participating emergency departments. Patients were randomized to receive a patient-specific or weight-based pain protocol. The authors compared continuous variables between the patient-specific and weight-based protocols with the 2-sample t test and categorical variables by the chi-square test.Results
The authors enrolled 104 participants. Compared with satisfaction with pain management on previous ED visits, more participants in the patient-specific protocol group than the weight-based group (57.1% vs 31.8%; P = .02) were satisfied with pain management. Most who were discharged home (91.2%) felt their pain was sufficiently relieved to be discharged home.Discussion
These findings support evidence-based guidelines to manage vaso-occlusive episodes in emergency departments. Patient-specific protocols can be implemented by partnering with local sickle cell disease providers to make protocols available in the emergency department.Type
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Ibemere, Stephanie O, Huiman Barnhart, John Myers, Joseph Miller, Ifeyinwa Osunkwo, Hayden B Bosworth, Caroline E Freiermuth, Robert Hughes, et al. (2025). Impact of Individualized Versus Weight-Based Pain Protocols on Patient Satisfaction for Patients With Sickle Cell Disease Experiencing a Vaso-Occlusive Episode. Journal of emergency nursing, 51(4). pp. 626–635. 10.1016/j.jen.2024.12.014 Retrieved from https://hdl.handle.net/10161/35432.
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Stephanie Ibemere
Stephanie Ibemere, PhD, MSN, RN, joined the Duke University School of Nursing faculty on July 1, 2021 as a faculty member of the Healthcare in Adult Populations division. Dr. Ibemere's program of research aims to increase access to high quality care and improved health outcomes for underserved adults with chronic diseases by developing community and culture-driven interventions which increase health equity while building health system and provider capacity for chronic disease management. Dr. Ibemere's current research focuses in the U.S., West and Eastern Africa. Dr. Ibemere's long term goal is to improve the clinical model of care for sickle cell disease in low to middle income settings both in Africa and in the United States by maximizing available resources and technology, tool adaptation, implementation science, and community-engaged research. Dr. Ibemere is also a collaborator on research teams aiming to promote equitable access to culturally centered healthcare interventions for other chronic conditions which disproportionately affect minoritized groups.
Dr. Ibemere holds Bachelor's of Science in Natural Sciences, Bachelor's of Arts in Spanish, and a Master's of Nursing in Clinical Nurse Leadership, all from Xavier University in Cincinnati, OH. Dr. Ibemere received her PhD in Nursing Research from the University of Cincinnati. Dr. Ibemere completed a postdoctoral fellowship at the Duke School of Nursing on a multisite evidence-based pain management protocol study for patients experiencing vaso-occlusive crisis while in the emergency department (COMPARE-VOE). As a clinical nurse, Dr. Ibemere has experience in global health capacity building in low to middle income countries related to sickle cell disease and other chronic diseases, clinical vaccine research, and cardiovascular critical care. Dr. Ibemere is a member of several professional organizations including the International Association of Sickle Cell Nurses and Professional Associates where she is a member of the education and marketing committees.
Huiman Xie Barnhart
My research interests include both statistical methodology and disease-specific clinical research biostatistics. My statistical research areas include methods for outcomes, endpoints, estimands, assessing reliability/agreement between methods or raters, evaluating performance of new medical diagnostic tests, and methods for design of clinical trials. My collaborative research include the following clinical areas: liver injury, cardiovascular imaging, radiology imaging, cardiovascular disease, renal disease, reproductive medicine, Parkinson disease, and aging.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
John J. Strouse
My research has focused on the epidemiology, risk factors, and prevention of the pulmonary and central nervous system complications of sickle cell disease and includes retrospective and prospective cohort studies and clinical trials. I received my Ph.D. in clinical investigation from the Johns Hopkins Bloomberg School of Public Health for a series of studies to identify predictors of cognitive function in children with sickle cell disease. This work has expanded to the evaluation of the interaction between environment and disease in both children and adults and the functional evaluation of adults with sickle cell disease. My other research interests include the application of large clinical, research, and administrative databases to the study of rare hematological diseases and interventions to improve quality of and access to care for sickle cell disease. I serve on the American Society of Hematology Sickle Cell Taskforce and Sickle Cell Pain Guideline Panel and am co-chair of the American Society of Hematology Healthcare Professional Education and Training Work Group.
Paula J Tanabe
Dr. Tanabe is the Laurel B. Chadwick Distinguished Professor in the Schools of Nursing and Medicine at Duke at the Duke University School of Nursing. Dr. Tanabe is a clinical and health services researcher. Her program of research focuses on improving systems of healthcare and patient outcomes for persons with sickle cell disease, a primarily minority and under-served population. Dr. Tanabe has received funding from the Agency for Health Care Research and Quality, the National Institute of Heart, Lung, and Blood, National Institute of Minority Health and Health Disparities and the National Institute of Nursing Research. Her work is advancing the care of individuals with sickle cell disease with a strong focus on improving pain management in the emergency department during a vaso-occlusive crisis. Her methodological expertise includes conducting multi-site clinical RCT’s, survey methods, qualitative research, quality improvement and implementation science. Dr. Tanabe has a strong passion for her work, individuals with sickle cell disease, and for mentoring students and faculty to conduct important, meaningful work to improve the health and well being of individuals and families.
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