Pain Management

Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research

Background

Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy.

Aim

The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature.

Methods

Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded.

Results

Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation).

Conclusions

Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.

Nurses' knowledge and attitudes about pain in hospitalized patients

PURPOSE

The purpose of the study was to measure knowledge and attitudes of nursing about pain management in patients before education, immediately after, and 6 months later. The end-point measure was Hospital Consumer Assessment of Healthcare Providers and Systems quarterly scores and percentile rank.

DESIGN

This longitudinal, quasi-experimental, quantitative study used survey method with pretest and posttest scores to measure immediate learning and 6 months later to measure sustained changes in knowledge and attitudes for nurses in this facility.

SETTING

The setting was a 360-bed acute care community hospital in the midsouth.

SAMPLE

The sample consisted of approximately 206 bedside nurses who worked in an acute care facility and 164 final posttest participants.

METHODS

The survey was used in a group setting immediately prior to a didactic learning experience. Immediately after the session, a posttest survey was administered. The 6-month follow-up occurred via an online module developed by the principal investigator. A repeated-measures analysis of variance, a pairwise comparison with a paired t test, and a Bonferroni correction were performed to determine if sustained knowledge and attitudes have changed.

FINDINGS

Posttest scores were significantly higher than pretest scores on the Knowledge and Attitudes Survey Regarding Pain immediately after a didactic education session and 6 months later (P < .017).

CONCLUSIONS

Six months later, scores remained higher than pretest or immediate posttest scores.

IMPLICATIONS

Nurses with a stronger knowledge base may lead to better pain management, improved outcomes, and higher patient satisfaction scores.

The effectiveness of continuing education in postoperative pain management: results from a follow-up study

BACKGROUND

Studies still report high levels of postoperative pain. Inadequate treatment of patients experiencing pain is often due to lack of understanding of pain.

METHODS

The objective of this study was to assess the effectiveness of a course on "pain," evaluated by a pretest-posttest design, with a questionnaire mailed to the 168 participants in February 2005. The course consisted of seven sessions held from October 2002 to June 2003 in a public hospital in Udine, Italy. This hospital has 710 beds and more than 30,000 admissions a year. The course, included in the "pain-free hospital" national objective, consisted of lectures, discussions, and role playing.

RESULTS

Of the 10 test questions participants answered, seven showed a significant difference between the posttest taken at the end of the course and the posttest taken after 18 months.

CONCLUSION

It is believed that knowledge is progressively lost if refresher courses are not held on a regular basis.