Background: Children undergoing Haematopoietic Stem Cell Transplantation (HSCT) are vulnerable to pain. 

Objective: The aim of this study was to examine how the contextual factors of a pediatric HSCT unit influenced the assessment of pain for hospitalized children by healthcare providers and parents.

Method: A qualitative case study was conducted in a tertiary level paediatric HSCT unit in two phases. Semi-structured interviews with parents were conducted at 30 and 90 days following HSCT therapy. Healthcare providers participated in naturalistic observations of pain-related care provided to children during their hospitalization for HSCT therapy and a semi-structured interview.

Results: The assessment of pain following transplantation by healthcare providers and parents was predominantly reliant on the observation of children for behaviours indicative of pain, rather than the application of validated pain assessment tools. Without formal measures of the pain experience, judgements regarding the severity of children’s pain were influenced by the context of high acuity of care post-transplantation and the emotional responses of healthcare providers and parent from bearing witness to children’s pain. 

Conclusion: Pain assessments mostly reflected children’s ability to tolerate pain, rather than genuine measurement of how significantly pain impacted on the child.