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Bishop FL, Cross N, Dewar-Haggart R, Teasdale E, Herbert A, Robinson ME, Ridd MJ, Mallen C, Clarson L, Bostock J, Becque T, Stuart B, Garfield K, Morrison L, Pollet S, Vennik J, Atherton H, Howick J, Leydon GM, Nuttall J, Islam N, Lee PH, Little P, Everitt HA. Talking in primary care (TIP): protocol for a cluster-randomised controlled trial in UK primary care to assess clinical and cost-effectiveness of communication skills e-learning for practitioners on patients' musculoskeletal pain and enablement. BMJ Open 2024; 14:e081932. [PMID: 38508652 PMCID: PMC10953007 DOI: 10.1136/bmjopen-2023-081932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/01/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Effective communication can help optimise healthcare interactions and patient outcomes. However, few interventions have been tested clinically, subjected to cost-effectiveness analysis or are sufficiently brief and well-described for implementation in primary care. This paper presents the protocol for determining the effectiveness and cost-effectiveness of a rigorously developed brief eLearning tool, EMPathicO, among patients with and without musculoskeletal pain. METHODS AND ANALYSIS A cluster randomised controlled trial in general practitioner (GP) surgeries in England and Wales serving patients from diverse geographic, socioeconomic and ethnic backgrounds. GP surgeries are randomised (1:1) to receive EMPathicO e-learning immediately, or at trial end. Eligible practitioners (eg, GPs, physiotherapists and nurse practitioners) are involved in managing primary care patients with musculoskeletal pain. Patient recruitment is managed by practice staff and researchers. Target recruitment is 840 adults with and 840 without musculoskeletal pain consulting face-to-face, by telephone or video. Patients complete web-based questionnaires at preconsultation baseline, 1 week and 1, 3 and 6 months later. There are two patient-reported primary outcomes: pain intensity and patient enablement. Cost-effectiveness is considered from the National Health Service and societal perspectives. Secondary and process measures include practitioner patterns of use of EMPathicO, practitioner-reported self-efficacy and intentions, patient-reported symptom severity, quality of life, satisfaction, perceptions of practitioner empathy and optimism, treatment expectancies, anxiety, depression and continuity of care. Purposive subsamples of patients, practitioners and practice staff take part in up to two qualitative, semistructured interviews. ETHICS APPROVAL AND DISSEMINATION Approved by the South Central Hampshire B Research Ethics Committee on 1 July 2022 and the Health Research Authority and Health and Care Research Wales on 6 July 2022 (REC reference 22/SC/0145; IRAS project ID 312208). Results will be disseminated via peer-reviewed academic publications, conference presentations and patient and practitioner outlets. If successful, EMPathicO could quickly be made available at a low cost to primary care practices across the country. TRIAL REGISTRATION NUMBER ISRCTN18010240.
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Affiliation(s)
| | - Nadia Cross
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Rachel Dewar-Haggart
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Emma Teasdale
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Amy Herbert
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Christian Mallen
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lorna Clarson
- Keele School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Jennifer Bostock
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Taeko Becque
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
| | - Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Sebastien Pollet
- School of Psychology, University of Southampton, Southampton, UK
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jane Vennik
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Helen Atherton
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
- Unit of Academic Primary Care, University of Warwick, Coventry, UK
| | - Jeremy Howick
- Leicester Medical School, University of Leicester, Leicester, UK
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Geraldine M Leydon
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nazrul Islam
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Paul H Lee
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
| | - Hazel A Everitt
- Primary Care Research Centre, School of Primary Care, Population Science, and Medical Education, University of Southampton, Southampton, UK
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Smith MD, Manning J, Nielsen M, Hayes SC, Plinsinga ML, Coppieters MW. Exploring women's experiences with persistent pain and pain management following breast cancer treatment: A qualitative study. FRONTIERS IN PAIN RESEARCH 2023; 4:1095377. [PMID: 36860333 PMCID: PMC9968918 DOI: 10.3389/fpain.2023.1095377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
This qualitative study aimed to explore experiences of women with persistent pain following breast cancer treatment, including their perceptions about the cause of their pain, how they manage their pain and their interactions with healthcare providers related to their pain during and following breast cancer treatment. Fourteen women who experienced pain for more than 3 months following breast cancer treatment were recruited from the general breast cancer survivorship community. Focus groups and in-depth, semi-structured interviews were conducted by one interviewer, audio-recorded, and transcribed verbatim. Transcripts were coded and analysed using Framework Analysis. Three main descriptive themes emerged from the interview transcripts: (1) characteristics of pain, (2) interactions with healthcare providers and (3) pain management. Women had various types and degrees of persistent pain, all of which they believed were related to breast cancer treatment. Most felt like they were not given enough information pre- or post-treatment and believed their experience and ability to cope with pain would have been better if they were given accurate information and advice about (the possibility of) experiencing persistent pain. Pain management strategies ranged from trial and error approaches, to pharmacotherapy, and to 'just coping with the pain". These findings highlight the importance of the provision of empathetic supportive care before, during and after cancer treatment that can facilitate access to relevant information, multidisciplinary care teams (including allied health professionals) and consumer support.
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Affiliation(s)
- Michelle D. Smith
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia,Correspondence: Michelle D. Smith
| | - Joanne Manning
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Mandy Nielsen
- AcquiredBrain Injury Transitional Rehabilitation Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia,Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Melanie L. Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia,Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Berthold SM, Feinn R, Bermudez-Millan A, Buckley T, Buxton OM, Kong S, Kuoch T, Scully M, Ngo TA, Wagner J. Self-reported pain among Cambodian Americans with depression: patient-provider communication as an overlooked social determinant. J Patient Rep Outcomes 2022; 6:103. [PMID: 36138333 PMCID: PMC9500135 DOI: 10.1186/s41687-022-00504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
Pain is common among torture survivors and refugees. Clear communication about one’s pain is vital to timely and precise diagnosis and treatment but is rarely recognized as a social determinant of health. We examined whether self-reported difficulty communicating with their health care provider, along with standard social determinants, is associated with self-reported pain in Cambodian American refugees.
Methods
Secondary data analysis was conducted on n = 186 baseline assessments from a diabetes prevention trial of Cambodian Americans with depression. Bilingual, bicultural community health workers (CHWs) conducted surveys including social determinants of health and past week pain occurrence and interference.
Results
The sample was 78% female, modal household income = $25,000, mean age = 55 years, and mean education = 6.9 years. About one-third had private insurance and two-thirds could not speak English conversationally. The average pain score was 2.8 on a scale from 0–8 with 37% reporting no pain at all. In bivariate analyses, predictors of higher pain scores were higher difficulty understanding healthcare provider, depressive symptoms, trauma symptoms, food insecurity, and social isolation; predictors of lower pain scores were higher years of education, income, English language proficiency, social support, working, and having private insurance. In the multivariate backward elimination model only two predictors were retained: difficulty understanding healthcare provider and depressive symptoms.
Discussion
We propose that healthcare communication is a modifiable social determinant of health. Healthcare institutions should receive the resources necessary to secure patients’ rights to clear communication including trained community health workers.
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Thompson L, Dowell A, Hilder J, Macdonald L, Stubbe M, Alchin J. How do patients and General Practitioners talk about pain and negotiate empathy in consultations? A direct observational study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e153-e162. [PMID: 33393707 DOI: 10.1111/hsc.13259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 10/07/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
The objective of this qualitative study in New Zealand was to investigate how general practitioners and patients discuss chronic pain in consultations. Chronic pain is a complex condition that defies many commonsense understandings. It is challenging to manage and patients can come to conclude that there is an empathy deficit. To our knowledge most, if not all, studies on this topic have recruited participants whose main presenting complaint is chronic pain. Forms of chronic pain are relatively common in the population and we thought it likely that at least some discussions may be rendered invisible via these recruiting practices. The study analysed data from the Applied Research on Communication in Health repository of audio transcripts and video-recorded consultations collected from a range of studies on a variety of topics, none of which were about chronic pain specifically. We searched the 256 transcripts looking for key words that might indicate that pain was at least part of the consultation. This yielded a large number of potentially relevant transcripts. These transcripts were assessed and reduced to 18 by excluding those that were about non-physical pain or pain that was expected to resolve relatively quickly. A medical specialist in chronic pain reviewed the resulting 18 and excluded two further transcripts giving us a final sample of 16. We conducted in-depth analysis of these consultations. Rather than confirming an empathy deficit, we found a much more complex deployment of empathy in the space where the two complex systems of chronic pain and general practice meet. These findings highlight the utility of analysing data originally generated for other purposes, with permission, and in a practical sense, highlight the importance of understanding empathy as highly contextual in 'real world' practice.
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Affiliation(s)
- Lee Thompson
- Department of Population Health/Te Tari Hauora Taupori, University of Otago/Te Whare Wānanga o Otāgo ki Ōtautahi, Christchurch, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, Te Tari Hauora Mātāmua me te Mātauranga Rata Whānau, University of Otago, Wellington, Wellington, New Zealand
| | - Jo Hilder
- Department of Primary Health Care and General Practice, Te Tari Hauora Mātāmua me te Mātauranga Rata Whānau, University of Otago, Wellington, Wellington, New Zealand
| | - Lindsay Macdonald
- Department of Primary Health Care and General Practice, Te Tari Hauora Mātāmua me te Mātauranga Rata Whānau, University of Otago, Wellington, Wellington, New Zealand
| | - Maria Stubbe
- Department of Primary Health Care and General Practice, Te Tari Hauora Mātāmua me te Mātauranga Rata Whānau, University of Otago, Wellington, Wellington, New Zealand
| | - John Alchin
- Canterbury District Health Board, Christchurch, New Zealand
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Hardman R, Lawn S, Tsourtos G. Pain Self-Management: Easier Said than Done? Factors Associated with Early Dropout from Pain Self-Management in a Rural Primary Care Population. PAIN MEDICINE 2020; 20:267-277. [PMID: 30203053 DOI: 10.1093/pm/pny167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low-socioeconomic status population. DESIGN Secondary analysis of retrospective data. SETTING Multidisciplinary pain clinic located in an outer regional area of Australia. SUBJECTS One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). METHODS Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. RESULTS Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). CONCLUSIONS In a rural, low-socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.
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Affiliation(s)
- Ruth Hardman
- Sunraysia Community Health Services, Mildura, Victoria, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, Adelaide, South Australia, Australia
| | - George Tsourtos
- Department of Public Health, Flinders University, Adelaide, South Australia, Australia
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Minnican C, O’Toole G. Exploring the incidence of culturally responsive communication in Australian healthcare: the first rapid review on this concept. BMC Health Serv Res 2020; 20:20. [PMID: 31910837 PMCID: PMC6947994 DOI: 10.1186/s12913-019-4859-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/22/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Increasing diversity in Australia requires healthcare practitioners to consider the cultural, linguistic, religious, sexual and racial/ethnic characteristics of service users as integral components of healthcare delivery. This highlights the need for culturally appropriate communication and care. Indeed the Australian Government in various policies mandates culturally responsive communication. Therefore this paper aims to provide a brief overview of Australian healthcare literature exploring the components; prevalence and effects of this style of communication in healthcare. METHODS A rapid review was conducted using the knowledge to action evidence summary approach. Articles included in the review were those reporting on the components, prevalence and outcomes of culturally responsive communication in Australian healthcare, published in English between 2008 and 2018. Articles were reviewed using reliable critical appraisal procedures. RESULTS Twenty- six articles were included in the final review (23 qualitative studies; 2 systematic reviews; 1 mixed methods study). The literature indicates knowledge of the positive effects of culturally responsive communication in healthcare. It also highlights the disparity between the perceptions of healthcare practitioners and services users over the existence and components of culturally responsive communication in healthcare. The review identified a limited use of this style of communication, but rather a focus on barriers to culturally appropriate care, lacking an awareness of the importance of culturally responsive communication in this care. CONCLUSION While literature suggests the importance and positive effects of culturally responsive communication, evidence suggests inconsistent implementation of this style of communication within Australian healthcare settings. This has implications for the outcomes of healthcare for the diverse population in Australia.
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Affiliation(s)
| | - Gjyn O’Toole
- Discipline of Occupational Therapy, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
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Lundberg T, Melander S. Key Push and Pull Factors Affecting Return to Work Identified by Patients With Long-Term Pain and General Practitioners in Sweden. QUALITATIVE HEALTH RESEARCH 2019; 29:1581-1594. [PMID: 30920899 DOI: 10.1177/1049732319837227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research shows that working is positive for people with long-term pain but that work-related support from health professionals is inadequate. One explanation for this inadequacy is that patients and providers differ in terms of perspectives on motivation to work. In this article, we compare factors that 31 patients and 15 general practitioners consider important to promote return to work for people with long-term pain. We analyzed the interviews with thematic analysis and a motivational push and pull framework to cover different motivational factors, societal and individual, that might push or pull patients from or toward work. Providers said that a difference between working and nonworking patients is their level of individual motivation, while the patients' stories showed that the main difference was the physical (non)ability to push themselves to work. We suggest that work-related support can be improved by addressing such differences in clinical practice.
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Burridge LH, Foster MM, Donald M, Zhang J, Russell AW, Jackson CL. A qualitative follow-up study of diabetes patients' appraisal of an integrated diabetes service in primary care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1031-1040. [PMID: 27782342 DOI: 10.1111/hsc.12402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 06/06/2023]
Abstract
As the prevalence of type 2 diabetes continues to escalate, health system reform is seeking better patient outcomes through new models of care that aim to provide the most appropriate care when needed. Patients' experiences of service innovations can shed light on the successes and challenges of implementing change. This paper explores patients' views of a new model of integrated care for patients with type 2 diabetes. A mixed-methods, randomised control trial evaluated a beacon clinic model of care for complex type 2 diabetes led by specialist general practitioners (GPs) in primary care settings in Brisbane, Australia. In this qualitative sub-study conducted between May 2014 and January 2015, 25 consenting participants were re-interviewed after 12 months using semi-structured questions, to explore their experiences of the new model of care. Interview transcripts were analysed thematically. In the first theme, Organised for patient-centred care, patients appraised the structural elements of the clinic. For most, it was an enabling experience which included convenience, flexibility and prompt communication back to the referring GPs. The preferences of a minority were partly realised, as they tried to understand the clinical purpose in comparison with traditional care. The second theme, Positioned as partners in care, revealed the pivotal role of patient-clinician relationships in patients' engagement with advice and self-care. Most found clinicians' collaborative approach engaging and motivating. A small minority with contextual concerns were disappointed with the focus on diabetes and struggled to engage fully with the model. Most participants valued this model of care, which reflects a capacity to manage the variable and complex needs of most patients referred for care. However, multi-level strategies are also needed to enhance patients' engagement with care and the sustainability of integrated diabetes care.
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Affiliation(s)
- Letitia H Burridge
- Discipline of General Practice, School of Medicine, The University of Queensland, Royal Brisbane & Women's Hospitals, Herston, Queensland, Australia
| | - Michele M Foster
- School of Human Services and Social Work, Menzies Health Institute of Queensland, Brisbane, Australia
| | - Maria Donald
- Discipline of General Practice, School of Medicine, The University of Queensland and School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jianzhen Zhang
- Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Claire L Jackson
- Discipline of General Practice, School of Medicine, The University of Queensland and School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
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Geurts JW, Willems PC, Lockwood C, van Kleef M, Kleijnen J, Dirksen C. Patient expectations for management of chronic non-cancer pain: A systematic review. Health Expect 2016; 20:1201-1217. [PMID: 28009082 PMCID: PMC5689237 DOI: 10.1111/hex.12527] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2016] [Indexed: 11/29/2022] Open
Abstract
Background Chronic pain is a major economic and social health problem. Up to 79% of chronic pain patients are unsatisfied with their pain management. Meeting patients’ expectations is likely to produce greater satisfaction with care. The challenge is to explore patients’ genuine expectations and needs. However, the term expectation encompasses several concepts and may concern different aspects of health‐care provision. Objective This review aimed to systematically collect information on types and subject of patients’ expectations for chronic pain management. Search strategy We searched for quantitative and qualitative studies. Because of the multidimensional character of the term “expectations,” the search included subject headings and free text words related to the concept of expectations. Data extraction and synthesis A framework for understanding patients’ expectations was used to map types of expectations within structure, process or outcome of health care. Main results Twenty‐three research papers met the inclusion criteria: 18 quantitative and five qualitative. This review found that assessment of patients’ expectations for treatment is mostly limited to outcome expectations (all 18 quantitative papers and four qualitative papers). Patients generally have high expectations regarding pain reduction after treatment, but expectations were higher when expressed as an ideal expectation (81‐93% relief) than as a predicted expectation (44‐64%). Discussion and conclusions For health‐care providers, for pain management and for pain research purposes, the awareness that patients express different types of expectations is important. For shared decision making in clinical practice, it is important that predicted expectations of the patient are known to the treating physician and discussed. Structure and process expectations are under‐represented in our findings. However, exploring and meeting patients’ expectations regarding structure, process and outcome aspects of pain management may increase patient satisfaction.
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Affiliation(s)
- Jose W Geurts
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul C Willems
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Craig Lockwood
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Maarten van Kleef
- Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Kleijnen Systematic Reviews Ltd, York, UK
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Jonsdottir T, Gunnarsdottir S, Oskarsson GK, Jonsdottir H. Patients' Perception of Chronic-Pain-Related Patient-Provider Communication in Relation to Sociodemographic and Pain-Related Variables: A Cross-Sectional Nationwide Study. Pain Manag Nurs 2016; 17:322-32. [PMID: 27553131 DOI: 10.1016/j.pmn.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 01/22/2023]
Abstract
Pain is a personal experience and patient-provider communication therefore an essential part of diagnosis and treatment where the patient's perspective needs to be central. The aim of this descriptive cross-sectional study was to investigate chronic-pain-related patient-provider communication in the context of sociodemographic variables, pain variables, perceived outcome of care, and satisfaction with health care providers. A postal questionnaire measuring socio-demographic variables, pain characteristics, pain-related health care utilization and patient-provider communication was sent to a sample of 4,500 individuals randomly drawn from the national population of Iceland. A subsample reporting chronic pain and having visited a health care provider for pain the previous six months (n = 401) was analyzed. Relationships between patient-provider communication and other measured variables were tested using bivariate and multivariate statistics. The more chronic pain impaired health-related quality of life, the more provider control the patients perceived in the patient-provider communication. There was also a strong negative relationship between patients' perception of providers' support and openness to discussing symptoms, and satisfaction with health care provider. Patients' perception of their own control in patient-provider communication and involvement in decisions regarding care was related to sociodemographic variables (specifically, education and residence) but not to pain related variables. This study highlights the importance of assessing chronic pain in a broad spectrum, listening, and giving patients time and support to communicate chronic pain and how it affects their life situation. The more interfering the pain is, the more important this is.
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Affiliation(s)
| | - Sigridur Gunnarsdottir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland; University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | | | - Helga Jonsdottir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland; University of Iceland, School of Health Sciences, Reykjavik, Iceland
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Tait RC, Chibnall JT, House K, Biehl J. Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives. PAIN MEDICINE 2015; 17:1269-81. [PMID: 26814299 DOI: 10.1093/pm/pnv076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 10/30/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. OBJECTIVE This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. DESIGN In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). SUBJECTS Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. RESULTS While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. CONCLUSIONS The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals.
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Affiliation(s)
- Raymond C Tait
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - John T Chibnall
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Kylie House
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joann Biehl
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Parahoo K. Interviews. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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