PROJECT SUMMARY/ABSTRACT Hispanic/Latino youth are at the highest risk for prescription opioid misuse for pain indications amongst all minority populations in the United States. There are few legitimate clinical indications for prescribing opioids to children and adolescents, as early opioid use is a known “gateway” to adulthood dependence and substance abuse disorders. Cancer and major surgery are two critical medical conditions that when put together, cause children and adolescents to experience significant pain from the time of diagnosis into adulthood as survivors and put them at higher risk for persistent and chronic prescription opioid use and dependency. In perioperative settings, clinical decisions on opioid prescribing are dependent on rapid, verbal communication of pain intensity levels and adverse events between the clinical staff, the pediatric patient, and most often, family members in the acute care setting. Spanish-speaking Hispanic/Latino patients and/or adult caregivers with limited English proficiency are forced to rely on the availability of institutional translation services or the presence of bilingual clinical staff, which may not be readily available or easy to use. These infrastructural barriers, exacerbated in low or middle-income hospitals, put these patients at higher risk of inaccurate pain assessments, both under and over-treatment of their pain, and exposure to inappropriate amounts of prescription opioids. Our goal is to reduce inaccurate assessment and treatment of pain and opioid prescribing in Hispanic/Latino children and adolescents with cancer undergoing major surgery with a rapid, dual English/Spanish-language, age-appropriate, engaging mobile augmented reality (AR) tool that can help them and their families to communicate information about their acute pain and pain-related adverse events in the immediate postoperative inpatient setting. To achieve this goal, we have collaborated with bilingual native Spanish- speaking pediatric anesthesiologists and pain specialists at the MD Anderson Cancer Center to develop the app with content relevant and engaging to Hispanic and non-Hispanic pediatric populations and will demonstrate the feasibility of implementing the app in the postoperative anesthesia care unit in a Phase I clinical trial. To our knowledge, there are no studies to investigate mobile AR for enhancing pain management focused on this population. As most children with cancer are expected to survive long-term, the benefits of preventing inappropriate prescription opioid use in this high-risk pain population will last over the lifetime of a child.

PROJECT NARRATIVE In this SBIR, ALTality, Inc. (“SpellBound”) will assess the feasibility of a dual English/Spanish language augmented reality(AR)-enabled tool for assessing inpatient postoperative pain/nausea/vomiting in Hispanic/Latino children and adolescents with cancer in collaboration with bilingual Spanish-speaking anesthesiologists at the MD Anderson Cancer Center. If successful, the AR app will be an immediately implementable and commercially viable method of providing Hispanic/Latino pediatric cancer patients with limited English proficiency an adjunctive tool to overcome infrastructural barriers to receiving translation services in acute care settings that put them at higher risk of under and/or overtreatment of pain by prescription opioids and future prescription opioid dependency and misuse, at no cost to them or their families.