Improving Pain mAnagement for childreN and young people attendeD by Ambulance (PANDA): A realist informed intervention development and feasibility study

Funding body


  • Health Education England (HEE)/National Institute for Health and Care Research (NIHR)
  • Funded as part of a HEE/NIHR Integrated Clinical and Practitioner Academic (ICA) Advanced Clinical and Practitioner Academic Fellowship (ACAF)
  • Ref: NIHR302875
Total funding £418,824


  • Dr. Gregory Whitley, Clinical Audit and Research Unit, East Midlands Ambulance Service NHS Trust & CaHRU, University of Lincoln [Chief Investigator]
  • Prof. Niro Siriwardena, CaHRU, University of Lincoln [Academic Mentor]
  • Prof. Sarah Redsell, Children and Young People’s Health Research, University of Nottingham [Academic Mentor]
  • Associate Prof. Paul Leighton, University of Nottingham [Academic Mentor]
  • Prof. Julia Williams, University of Hertfordshire [Professional Mentor]
  • Associate Prof. Bill Lord, Monash University [Professional Mentor]
  • Prof. Graham Law, CaHRU, University of Lincoln [Collaborator]
  • Dr. Jessica Hodgson, University of Lincoln [Collaborator]
  • Dr. Sarah Wilde, Lincolnshire Partnership NHS Foundation Trust & University of Lincoln [Collaborator]
  • Dr. Michael Baliousis, Nottingham University Hospitals NHS Trust & University of Lincoln [Collaborator]
  • Amanda Brewster, HAPPI Group, University of Lincoln [PPIE]
  • Young Persons Advisory Group (YPAG) co-leads
Overarching aim The aim of this PANDA study is to explore the experiences of children and young people (CYP) who have been attended by ambulance for a painful condition, along with their parents/carers and ambulance clinicians and to develop and test a new method to improve pain management.


  1. Develop initial programme theories by reviewing existing published and grey literature on interventions and quality improvement initiatives for CYP suffering pain in the pre-hospital setting. [WP1]
  2. Refine the initial programme theories and develop middle range programme theories by exploring the experiences of CYP, parents/carers and ambulance clinicians and analysing clinical record data regarding the acute pain management process to determine which interventions work for whom, the mechanisms by which they work and in what context. [WP2a]
  3. Determine the practical delivery of the middle range programme theories [develop an intervention in collaboration with key stakeholders]. [WP2b]
  4. Test the middle range programme theories by testing the feasibility of the intervention and measure feasibility outcomes. [WP3]
Methods Utilising a realist approach and following the Medical Research Council guidelines for complex intervention development, a realist informed intervention development and feasibility study will be conducted. The intervention will be co-produced with a Young Persons Advisory Group (YPAG).

  • Work Package (WP)1: A realist review of existing interventions, quality improvement initiatives, guidelines and policies to improve pain management in CYP in the pre-hospital setting will help us understand context, mechanism and outcome configurations (CMOC) and will facilitate the development of initial programme theories (IPTs).
  • WP2: We will conduct a realist evaluation involving a multiple case study (WP2a) and a consensus workshop (WP2b). WP2a will use interviews, diaries and arts-based methods with CYP, their parents/carers and ambulance clinicians to determine which interventions work for whom, the mechanisms (M) by which they work and in what context (C). We will also analyse clinical record data to incorporate outcome (O) measures such as pain score. These data will allow us to refine the IPTs and develop more middle range programme theories. WP2b will use the consensus workshop method to determine the practical delivery of the middle range programme theories; an intervention will be developed, mapped to the Capability, Opportunity, Motivation, Behaviour (COM-B) model.
  • WP3: A cluster feasibility randomised controlled trial and process evaluation will be conducted. Paramedics will be randomised 1:1 to receive the intervention or not (standard care). The intervention may, for example, include training/education, feedback or pain management prompts. CYP and parents/carers will be approached after treatment for consent to use their routine data and follow up at 1 and 3 months to assess pain level, sleep disturbance and post-traumatic stress disorder rates. Interviews will be conducted with paramedics, CYP and parents/carers to determine acceptability and understand the mechanisms by which the intervention works.


We are hoping to develop an acceptable and feasible intervention that aims to reduce the severity of acute pain experienced by children and young people when they are attended by an ambulance.
Outputs Findings from this study will be presented at conferences, published in peer reviewed journals and promoted via social media. An executive summary of findings will be submitted to the Association of Ambulance Chief Executives.We will produce an animated video describing in simple terms the PANDA findings. This will be promoted via social media channels and embedded into core websites such as the CaHRU website and promoted through key organisational social media channels (University of Lincoln and East Midlands Ambulance Service NHS Trust).


The PANDA study should result in the production of a complex intervention that is deemed feasible and acceptable for formal evaluation within a clinical trial. The future clinical trial will determine the clinical and cost effectiveness of the intervention. This may provide the evidence needed for widespread implementation and adoption of the new intervention within ambulance services across the UK and internationally.

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