Producing systemic change in pediatric practice: An intervention protocol for reducing distress during painful procedures

We describe the process of designing, implementing, and evaluating a family-centered, combined pharmacologic-psychologic intervention for procedural pain in pediatric leukemia. The program, the Analgesia Protocol for Procedures in Oncology (APPO), is consistent with family systems frameworks. APPO emphasizes the competence of families in coping with serious pediatric illness and the importance of the roles of multidisciplinary staff in the development of efforts directed at changing clinical practice. Change is viewed as a process of achievements and resistance. The importance of an integrated research perspective is highlighted throughout.