A Systematic Approach to Developing Virtual Patient Vignettes for Pediatric Health Equity Research

Abstract

Objective: The aim of this study was to describe a systematic approach to developing virtual patient (VP) vignettes for health equity research in pediatric pain care.

Methods: VPs were initially developed to depict the body posture and movements of actual children experiencing pain. Researchers and clinicians with expertise in pediatric pain worked closely with a professional animator to portray empirically supported pain expression in four, full-motion, virtual male characters of two races (i.e., White and Black). Through an iterative process, VPs were refined to (1) appear realistic in a clinical setting and (2) display archetypal pain behavior and expression during a 1-min video clip without sound. Text vignettes were developed with consultation from experts in pain care and presented alongside VPs to assess clinical decision-making. VP vignettes were piloted in a sample of pediatric providers (N=13).

Results: Informed by the literature and expertise of stakeholders, several revisions were made to improve VPs' facial grimacing and realism before piloting. VPs appeared to accurately capture important aspects of pain expression and behavior common among pediatric patients with pain disorders. Additional refinements to the text vignettes were made based on provider feedback to improve clarity and clinical relevance.

Conclusions: This article presents a working framework to facilitate a systematic approach to developing VP vignettes. This framework is a first step toward advancing health equity research by isolating psychosocial and interpersonal factors affecting provider behavior and decision-making. Future research is needed to validate the use of VP vignettes for assessing provider behavior contributing to health inequities for youth with pain disorders.

Keywords: health equity; pain management; pediatrics; virtual human technology.

FIG. 1.

Still-frame of pain expression for a Black virtual patient.

FIG. 2.

Still-frame of pain expression for a White virtual patient.

[Table: see text] John is a 16-year-old African American male with HgSS who presents to the emergency department with back pain. His pain started last night. John describes his pain as sharp and throbbing and rates it as 8 of 10. He has missed several days of school this month because of pain. He also reports sleeping difficulties and feeling tired during the day. His physical examination is unremarkable except for moderate tenderness in the lower back. His laboratory values are normal. John reports that he is completely out of his prescription pain medication (oxycodone) and says he has been taking over-the-counter medications, but none have been helpful for his pain. [Table: see text] FIG. 3. Virtual patient vignette, Black adolescent with sickle cell pain.

[Table: see text] Lucas is a 17-year-old White male with acute lymphoblastic leukemia (ALL), on chemotherapy, who presents to the emergency department with back pain. His most recent pain reportedly started last night. Lucas describes his pain as sharp and throbbing and rates it as 8 of 10. He also reports sleeping difficulties and feeling tired during the day. His physical examination is unremarkable except for moderate tenderness in the lower back. His laboratory values are normal. Lucas reports taking prescription pain medication (dilaudid), which recently ran out, and indicates that it was not helpful for his pain. [Table: see text] FIG. 4. Virtual patient vignette, White adolescent with cancer pain.