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Shepherd WS, Wiese AD, Cho HE, Rork WC, Baig MU, Kostick KM, Nguyen D, Carter EM, Murali CN, Robinson ME, Schneider SC, Lee B, Sutton VR, Storch EA. Psychosocial Outcomes of Pain and Pain Management in Adults with Osteogenesis Imperfecta: A Qualitative Study. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09991-z. [PMID: 38281305 DOI: 10.1007/s10880-023-09991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/30/2024]
Abstract
Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.
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Affiliation(s)
- Whitney S Shepherd
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Hannah E Cho
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - W Conor Rork
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M Usman Baig
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Dianne Nguyen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Erin M Carter
- Hospital for Special Surgery, New York City, NY, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | | | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA
| | - Brendan Lee
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX, 77030, USA.
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Lee EM, Jiménez-Fonseca P, Carmona-Bayonas A, Hernández R, Cruz-Castellanos P, Obispo B, Antoñanzas-Basa M, Palacín-Lois M, Castillo-Trujillo OA, Calderon C. Clinicians' and Advanced Cancer Patients' Estimates of Treatment Efficacy and Toxicity in Oncologic Treatment. Healthcare (Basel) 2023; 11:2222. [PMID: 37570462 PMCID: PMC10419268 DOI: 10.3390/healthcare11152222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
The purpose of the study was to compare curability expectations between clinicians and patients and examine the influence of sociodemographic and clinical variables on these expectations and satisfaction within the clinician-patient relationship. This prospective study, conducted from February 2020 to May 2023, involved 986 advanced cancer patients. The patients completed questionnaires assessing treatment efficacy and toxicity predictions and the Scale to Assess the Therapeutic Relationship (STAR). Seventy-four percent of advanced cancer patients had an inaccurate perception of treatment curability. Clinicians perceived male patients with lung or digestive cancer without adenocarcinoma at locally advanced stages, with fewer comorbidities and better functional status (ECOG), as having higher curability expectations. Clinicians tended to have more realistic expectations than patients, since they had to consider the presence of treatment's side effects, while patients underestimated the possibility of experiencing these adverse effects. Patients who had more favorable expectations regarding survival and quality of life were found to be more satisfied with the care provided by their oncologists. It is crucial for patients to understand the treatment goals and establish realistic expectations in order to actively participate in decision-making and achieve a better quality of life at the end of life.
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Affiliation(s)
- Eun Mi Lee
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, 33007 Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Department of Medical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, 30008 Murcia, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, 38320 Tenerife, Spain
| | | | - Berta Obispo
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | | | | | - Oscar A. Castillo-Trujillo
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, 33007 Oviedo, Spain
| | - Caterina Calderon
- Faculty of Psychology, University of Barcelona, 08007 Barcelona, Spain
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van Rysewyk S. A perspective on the role of language about pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1251676. [PMID: 37599863 PMCID: PMC10433376 DOI: 10.3389/fpain.2023.1251676] [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: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023] Open
Abstract
This article contributes a perspective on pain motivated by the philosopher Ludwig Wittgenstein. According to Wittgenstein, the child learns from others that the occasions on which it manifests certain reactions-the reactions that human beings manifest when injured-make it appropriate to self-ascribe "pain". When the child can signal correctly that she is in the requisite bodily state, then she has a conception of pain. Using the concept pain to symbolise an experience also makes it possible to tell other people what is going on and to solicit their help in managing the pain. In pain discourse, we can say "Sam can tell that Jason is with pain", or "She could tell you that Jason is with pain if she wanted to". These uses are linked to social milieu where rules are learnt for the application of concepts, such as the concept stoicism. In many rural communities, adults tell other adults about pain when it interrupts work or social activities. Otherwise, it is normative to "carry on". The rural stoic who tells another about pain only if he wants to can complicate clinical pain management, which can undermine the patient's special authority. In contrast, convergence in pain definitions and judgements between the patient and health professional can protect the authority of the patient and improve the clinical interaction. Pain is not simply a quale that is privately perceived; it must be capable of being expressed. Thus, pain has a social role, which is learnt. The study of linguistic rules in pain discourse could help explain the learning and application of the concept pain.
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Affiliation(s)
- Simon van Rysewyk
- Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart, TAS, Australia
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Gomez D, Carmona-Bayonas A, Hernandez R, Higuera O, Rogado J, Pacheco-Barcia V, Valero M, Gil-Raga M, Mar Muñoz M, Carrión-Galindo R, Jimenez-Fonseca P, Calderon C. Stoic attitude in patients with cancer from the NEOcoping study: Cross-sectional study. PLoS One 2022; 17:e0269712. [PMID: 35901019 PMCID: PMC9333303 DOI: 10.1371/journal.pone.0269712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
Aim Stoicism has been applied to describe a wide range of behaviors in the face of disease and influences an individual’s use of coping strategies. This study tested the relationship between stoicism and social support, optimism, psychological distress, and coping strategies in patients with cancer. Method NEOcoping is a multicenter, cross-sectional study. Participants’ data were collected using a standardized, self-report form and LSS, MSPSS, Mini-MAC, BSI-18, and LOT-R questionnaires. Linear regression analyses were used to assess the association between stoicism and distress scores in both genders. A total of 932 individuals with non-metastatic, resected cancer were recruited. Results Males perceived a higher risk of recurrence and toxicity with adjuvant chemotherapy and obtained higher stoic attitude scores than females. Women scored higher on somatization, depression, and anxiety. Patients with high stoicism scores were older and experienced more maladaptive coping (helplessness, anxious preoccupation), and depression, while those with lower stoicism scores had greater perceived social support, optimism, and positive attitude. In both males and females, stoicism correlated negatively with perceived social support, optimism, and positive attitude, and positively with helplessness, anxious preoccupation, and depression. In men, stoicism was directly and negatively associated with social support and optimism, and positively with anxious preoccupation. In women, stoicism was positively associated. In women, stoicism was directly and negatively associated with social support and positively with age and optimism. Stoicism was directly and positively associated with helplessness. Discussion A stoic attitude was associated with lower social support, reduced optimism, and passive coping strategies (helplessness and anxious preoccupation) in this series of patients with cancer.
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Affiliation(s)
- David Gomez
- Department of Medical Oncology, Hospital Universitario Central of Asturias, IPSA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Department of Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB), UMU, Murcia, Spain
| | - Raquel Hernandez
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Oliver Higuera
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Vilma Pacheco-Barcia
- Department of Medical Oncology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
| | - María Valero
- Department of Medical Oncology, Hospital Quirón salud Sagrado Corazón, Sevilla, Spain
| | - Mireia Gil-Raga
- Department of Medical Oncology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Mª Mar Muñoz
- Department of Medical Oncology, Hospital Virgen de La Luz, Cuenca, Spain
| | - Rafael Carrión-Galindo
- Department of Medical Oncology, Hospital Universitario del Sureste, Arganda del Rey-Madrid, Spain
| | | | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- * E-mail:
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Fowler Davis S, Humphreys H, Maden-Wilkinson T, Withers S, Lowe A, Copeland RJ. Understanding the Needs and Priorities of People Living with Persistent Pain and Long-Term Musculoskeletal Conditions during the COVID-19 Pandemic—A Public Involvement Project. Healthcare (Basel) 2022; 10:healthcare10061130. [PMID: 35742180 PMCID: PMC9222303 DOI: 10.3390/healthcare10061130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Critiques of public involvement (PI) are associated with failing to be inclusive of under-represented groups, and this leads to research that fails to include a diversity of perspectives. Aim: The aim of this PI project was to understand the experiences and priorities of people from three seldom-heard groups whose musculoskeletal pain may have been exacerbated or treatment delayed due to COVID-19. Engaging representatives to report diverse experiences was important, given the goal of developing further research into personalised and integrated care and addressing population health concerns about access and self-management for people with musculoskeletal pain. Methods: The project was approved via Sheffield Hallam University Ethics but was exempt from further HRA approval. A literature review was conducted, followed by informal individual and group discussions involving professionals and people with lived experience of (a) fibromyalgia pain, (b) those waiting for elective surgery and (c) experts associated with the care home sector. Findings from the literature review were combined with the insights from the public involvement. Resulting narratives were developed to highlight the challenges associated with persistent pain and informed the creation of consensus statements on the priorities for service improvement and future research. The consensus statements were shared and refined with input from an expert steering group. Results: The narratives describe pain as a uniformly difficult experience to share with professionals; it is described as exhausting, frustrating and socially limiting. Pain leads to exclusion from routine daily activities and often resigns people to feeling and being unwell. In all cases, there are concerns about accessing and improving services and critical issues associated with optimising physical activity, functional wellbeing and managing polypharmacy. Exercise and/or mobilisation are important and commonly used self-management strategies, but opportunity and advice about safe methods are variable. Services should focus on personalised care, including self-management support and medication management, so that people’s views and needs are heard and validated by health professionals. Conclusions: More research is needed to explore the most effective pain management strategies, and public involvement is important to shape the most relevant research questions. Health and care systems evaluation is also needed to address the scale of the population health need. The pandemic appears to have highlighted pre-existing shortcomings in holistic pain management.
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Affiliation(s)
- Sally Fowler Davis
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
- Correspondence:
| | - Helen Humphreys
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Tom Maden-Wilkinson
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Sarah Withers
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Broomhall, Sheffield S10 2JF, UK;
| | - Anna Lowe
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
| | - Robert J. Copeland
- Organisation in Health and Care, Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK; (H.H.); (T.M.-W.); (A.L.); (R.J.C.)
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Lombard D. Person-centred communication in long-term care with older people: a scoping review. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2020-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PurposeInterpersonal skills are increasingly important tools in long-term care with older people, especially against the backdrop of loneliness affecting older people and expectations for a person-centred, joined-up approach. However, the term is used as a composite and its definition lacks shape and focus. In existing literature, participants appear to be selected on the basis of specific illnesses rather than age. Better understanding of the features of everyday communication processes associated with person-centred care can lead to improvements in policy and practice.Design/methodology/approachA scoping review examined communication features associated with person-centred care for older adults. This identified the extent and nature of literature. Several databases were searched; after screening and hand-searching, 31 were included. Findings were analysed for patterns and contradictions, against the objectives of person-centred and integrated care.FindingsEmotional intelligence and the ability to employ various communication styles are crucial skills of person-centred communication. Such approaches can have positive effects on the well-being of older people.Research limitations/implicationsSome studies' validity was weakened by methodological designs being founded on value judgements.Practical implicationsUsing personalised greetings alongside verbal and non-verbal prompts to keep residents emotionally connected during personal care is considered good practice. Stimulating feedback from people using services and their relatives is important.Originality/valueThe role of communication is highlighted in many professional guidance documents on person-centred and integrated care, but the process of implementation is decentralised to individual employers and workers. This paper draws on the findings of contemporary literature, grounded in naturalistic data, with implications for practice and policy.
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Wright RC, Junghaenel DU, Rivas R, Hristidis V, Robbins ML. A new approach to capturing pain disclosure in daily life in-person and online. J Health Psychol 2020; 26:2577-2591. [PMID: 32419503 DOI: 10.1177/1359105320918322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This feasibility study employed a new approach to capturing pain disclosure in face-to-face and online interactions, using a newly developed tool. In Study 1, 13 rheumatoid arthritis and 52 breast cancer patients wore the Electronically Activated Recorder to acoustically sample participants' natural conversations. Study 2 obtained data from two publicly available online social networks: fibromyalgia (343,439 posts) and rheumatoid arthritis (12,430 posts). Pain disclosure, versus non-pain disclosure, posts had a greater number of replies, and greater engagement indexed by language style matching. These studies yielded novel, multimethod evidence of how pain disclosure unfolds in naturally occurring social contexts in everyday life.
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Henry SG, Matthias MS. Patient-Clinician Communication About Pain: A Conceptual Model and Narrative Review. PAIN MEDICINE 2019; 19:2154-2165. [PMID: 29401356 DOI: 10.1093/pm/pny003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Productive patient-clinician communication is an important component of effective pain management, but we know little about how patients and clinicians actually talk about pain in clinical settings and how it might be improved to produce better patient outcomes. The objective of this review was to create a conceptual model of patient-clinician communication about noncancer pain, review and synthesize empirical research in this area, and identify priorities for future research. Methods A conceptual model was developed that drew on existing pain and health communication research. CINAHL, EMBASE, and PubMed were searched to find studies reporting empirical data on patient-clinician communication about noncancer pain; results were supplemented with manual searches. Studies were categorized and analyzed to identify crosscutting themes and inform model development. Results The conceptual model comprised the following components: contextual factors, clinical interaction, attitudes and beliefs, and outcomes. Thirty-nine studies met inclusion criteria and were analyzed based on model components. Studies varied widely in quality, methodology, and sample size. Two provisional conclusions were identified: contrary to what is often reported in the literature, discussions about analgesics are most frequently characterized by patient-clinician agreement, and self-presentation during patient-clinician interactions plays an important role in communication about pain and opioids. Conclusions Published studies on patient-clinician communication about noncancer pain are few and diverse. The conceptual model presented here can help to identify knowledge gaps and guide future research on communication about pain. Investigating the links between communication and pain-related outcomes is an important priority for future research.
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Affiliation(s)
- Stephen G Henry
- Department of Internal Medicine, University of California Davis, Sacramento, California
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, Indiana.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Gray AC, Steel A, Adams J. A critical integrative review of complementary medicine education research: key issues and empirical gaps. Altern Ther Health Med 2019; 19:73. [PMID: 30894151 PMCID: PMC6427897 DOI: 10.1186/s12906-019-2466-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022]
Abstract
Background Complementary Medicine (CM) continues to thrive across many countries. Closely related to the continuing popularity of CM has been an increased number of enrolments at CM education institutions across the public and private tertiary sectors. Despite the popularity of CM across the globe and growth in CM education/education providers, to date, there has been no critical review of peer-reviewed research examining CM education undertaken. In direct response to this important gap, this paper reports the first critical review of contemporary literature examining CM education research. Methods A review was undertaken of research to identify empirical research papers reporting on CM education published between 2005 and 17. The search was conducted in May 2017 and included the search of PubMed and EBSCO (CINAHL, MEDLINE, AMED) for search terms embracing CM and education. Identified studies were evaluated using the STROBE, SRQP and MMAT appraisal tools. Results From 9496 identified papers, 18 met the review inclusion criteria (English language, original empirical research data, reporting on the prevalence or nature of the education of CM practitioners), and highlighted four broad issues: CM education provision; the development of educational competencies to develop clinical skills and standards; the application of new educational theory, methods and technology in CM; and future challenges facing CM education. This critical integrative review highlights two key issues of interest and significance for CM educational institutions, CM regulators and researchers, and points to number of significant gaps in this area of research. There is very sporadic coverage of research in CM education. The clear absence of the robust and mature research regarding educational technology and e-learning taking place in medical and or allied health education research is notably absent within CM educational research. Conclusion Despite the high levels of CM use in the community, and the thriving nature of CM educational institutions globally, the current evidence evaluating the procedures, effectiveness and outcomes of CM education remains limited on a number of fronts. There is an urgent need to establish a strategic research agenda around this important aspect of health care education with the overarching goal to ensure a well-educated and effective health care workforce.
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Lane P, Smith D. Culture, Ageing and the Construction of Pain. Geriatrics (Basel) 2018; 3:E40. [PMID: 31011078 PMCID: PMC6319244 DOI: 10.3390/geriatrics3030040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 01/12/2023] Open
Abstract
In this paper, the authors seek to discuss some of the complexities involved in cross-cultural working in relation to the communication and management of pain in older people. Specifically, the paper addresses the culture construction of ageing and how pain is often constructed as a natural part of ageing. The authors also suggest that with the rise of the ideology of active-ageing, many older people who are disabled or living in chronic pain, may feel a moral imperative to hide pain and ill-health. The discussion extends into looking at the impact of culture and the communication of pain, including specific idioms of distress, somaticize and the lay-management of pain through stoicism. The literature utilised in this paper was based on a thematic review, exploring the cultural dimensions of health, illness and pain in old age. The review also drew on the authors' previous publications, as well as their extensive community research experience working with ethnic minority communities.
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Affiliation(s)
- Pauline Lane
- Faculty of Health Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, CM1 1SQ, UK.
| | - David Smith
- Faculty of Health Social Care and Education, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, CM1 1SQ, UK.
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Toye F, Seers K, Barker K. A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundPeople with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.Objectives(1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs.DesignWe used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument.Data sourcesWe searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings.ResultsWe screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (seeReport Supplementary Material 1; URL:www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy.LimitationsThere are no agreed methods for determining confidence in QESs.ConclusionsWe highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain.Future workFuture work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Toye F, Seers K, Barker KL. Meta-ethnography to understand healthcare professionals' experience of treating adults with chronic non-malignant pain. BMJ Open 2017; 7:e018411. [PMID: 29273663 PMCID: PMC5778293 DOI: 10.1136/bmjopen-2017-018411] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to explore healthcare professionals' experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care. DESIGN Qualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals' experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings. RESULTS We screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high. CONCLUSIONS This is the first qualitative evidence synthesis of healthcare professionals' experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.
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Affiliation(s)
- Francine Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Seers
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Gorawara-Bhat R, Wong A, Dale W, Hogan T. Nurses' perceptions of pain management for older-patients in the Emergency Department: A qualitative study. PATIENT EDUCATION AND COUNSELING 2017; 100:231-241. [PMID: 27591825 DOI: 10.1016/j.pec.2016.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 08/18/2016] [Accepted: 08/19/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES 1) Identify themes arising from nurses' perceptions of assessing older-patients' pain; 2) use themes to guide development of optimal interventions to improve quality of pain assessment in the emergency department (ED). METHODS Nurse interviews (n=20) were conducted until theme saturation. They were transcribed, coded, and analyzed using qualitative methodology. RESULTS Two major themes-nurse 'challenges' and 'strategies' to overcome challenges, and their subthemes - classified as 'patient-related' or 'system-related,' were salient in nurses' perceptions. Strategies nurses reported for managing challenges were based in their own professional lived experiences. DISCUSSION AND CONCLUSION A 2×2 framework was developed to conceptualize challenges, strategies, subthemes and their classifications, yielding 4 typologies comprising challenge types matched with appropriate strategy types. While emergent challenges and strategies are corroborated in the literature, the present study is the first to develop a scheme of typologies beneficial for guiding the development of optimal interventions to improve the quality of assessing pain in older-patients. PRACTICE IMPLICATIONS The typology framework can guide the development of pain assessment tools and the needed combinations for assessing multidimensional pain in older-patients. Using the present findings, a new clinical intervention was shown to significantly improve pain management for older-patients in the ED.
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Affiliation(s)
| | - Alexandra Wong
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - William Dale
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA
| | - Teresita Hogan
- Section of Geriatrics and Palliative Medicine, Chicago, IL, USA; Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA
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Andrade AM, Silva KL, Seixas CT, Braga PP. Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura. Rev Bras Enferm 2017; 70:210-219. [DOI: 10.1590/0034-7167-2016-0214] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/24/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a produção científica acerca da atuação do enfermeiro na atenção domiciliar em saúde. Método: realizou-se uma revisão integrativa da literatura por meio de consulta às bases de dados LILACS, BDENF, IBECS e MEDLINE. Foram incluídos estudos em espanhol, inglês e português, não delimitando data de publicação. Resultados: analisados 48 artigos, identificou-se que a atuação do enfermeiro na atenção domiciliar possui complexidade e diversidade de ações com uso de tecnologias leves, leve-duras especialmente, e duras. Destaca-se que desafios relacionados ao processo formativo para a atenção domiciliar estão relatados na literatura. O enfermeiro utiliza conhecimento experiencial e recomendações científicas aliados à reflexão na prática. Conclusão: a atuação do enfermeiro no espaço domiciliar é fundamental e ampla. As ações relacionais e educacionais se destacam, sendo necessárias inclusive nos cuidados técnicos, predominando a necessidade de formação para a atenção domiciliar.
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Affiliation(s)
| | - Kênia Lara Silva
- Universidade Federal de Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Brazil
| | - Clarissa Terenzi Seixas
- Universidade Federal de Minas Gerais, Brazil; Universidade do Estado do Rio de Janeiro, Brazil
| | - Patrícia Pinto Braga
- Universidade Federal de Minas Gerais, Brazil; Universidade Federal de São João Del-Rei, Brazil
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Parry R, Pino M, Faull C, Feathers L. Acceptability and design of video-based research on healthcare communication: Evidence and recommendations. PATIENT EDUCATION AND COUNSELING 2016; 99:1271-1284. [PMID: 27066862 DOI: 10.1016/j.pec.2016.03.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/27/2016] [Accepted: 03/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To contribute to understandings about acceptability and risks entailed in video-based research on healthcare communication. To generate recommendations for non-covert video-based research on healthcare communication - with a focus on maximising its acceptability to participants, and managing and reducing its risks. METHODS A literature review and synthesis of (a) empirical research on participant acceptability and risks of video recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific). RESULTS 36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication: CONCLUSION AND PRACTICE IMPLICATIONS The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available.
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Affiliation(s)
- Ruth Parry
- Health Sciences, University of Nottingham, Nottingham, UK
| | - Marco Pino
- Health Sciences, University of Nottingham, Nottingham, UK
| | - Christina Faull
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK
| | - Luke Feathers
- LOROS Hospice Care for Leicestershire and Rutland, and Medicine University Hospitals Leicester, UK.
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Macdonald LM. Expertise in Everyday Nurse-Patient Conversations: The Importance of Small Talk. Glob Qual Nurs Res 2016; 3:2333393616643201. [PMID: 28462336 PMCID: PMC5342634 DOI: 10.1177/2333393616643201] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 12/31/2022] Open
Abstract
A great deal of nursing activity is embedded in what is considered to be everyday conversation. These conversations are important to health professionals because communication can affect health outcomes, and they are important to patients who want to know they are being heard and cared for. How do nurses talk with patients and what are the features of effective communication in practice? In this exploratory study, two expert nurses recorded conversations with patients during domiciliary visits. Linguistic discourse analysis, informed by contextual knowledge of domiciliary nursing shows the nurses skillfully used small talk to support their clinical work. In their conversations, nurses elicit specific information, normalize unpleasant procedures, manage the flow of the interaction, and strengthen the therapeutic relationship. Small talk can be big talk in achieving nursing goals. Critically reflecting on recorded clinical interactions can be a useful method of professional development and a way of demonstrating nursing expertise.
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Koskinen C, Aho S, Nyholm L. Life with an unwelcome guest - caring in a context of protracted bodily pain. Scand J Caring Sci 2016; 30:774-781. [PMID: 26810173 DOI: 10.1111/scs.12304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/23/2015] [Indexed: 12/01/2022]
Abstract
Protracted bodily pain is a phenomenon that often affects a human being's whole life. Care of human beings with protracted pain is challenging because pain is not always measureable, and the experiences of pain are subjective, unique and shapeshifting. Therefore, the aim is to highlight what protracted bodily pain signifies for the human being, and human beings' experiences of what is caring in a context of protracted bodily pain. Four informants with protracted bodily pain took part in a focus group interview. The interview was analysed by using a qualitative content analysis with a hermeneutic approach. The findings show that protracted pain renders human beings speechless, limits and robs them of their lives. The pain is described as a domineering, unpleasant and unwelcome guest. The pain can change the human being's personality and creates feelings of guilt. Uncertainty about the origin of the pain as well as a nonchalant treatment or not being believed intensifies the pain. Human being experience mastering the pain, encounters with caregivers who can ease the burden, community with others and finding that little something extra in everyday life is experienced as caring. From a caring science perspective, the relation between protracted pain and suffering is obvious. Suffering emerges as illness suffering, as life suffering and as suffering caused by care. Professional as well as natural caring is important in a context of protracted bodily pain. The human being longs to encounter caregivers who are courageous enough to lay themselves on the line. Community with people who are prepared to share the burden eases the heavy burden that pain brings to life, it brings hope and relief.
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Affiliation(s)
- Camilla Koskinen
- Department of Caring Science, Åbo Akademi University, Vaasa, Finland
| | - Sonja Aho
- Department of Caring Science, Åbo Akademi University, Vaasa, Finland
| | - Linda Nyholm
- Department of Caring Science, Åbo Akademi University, Vaasa, Finland
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A Debate on the Proposition that Self-report is the Gold Standard in Assessment of Pediatric Pain Intensity. Clin J Pain 2015; 31:707-12. [DOI: 10.1097/ajp.0000000000000165] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Too many older adults live with the negative consequences of chronic pain and its detrimental impact on quality of life. To explore this, an extended literature review was conducted to identify barriers the older person encountered in the self-reporting of their chronic pain. Four themes were found to mediate help-seeking behaviour. Attitudes such as stoicism, beliefs such as pain being a necessary part of ageing, and the external barriers generated by health professionals, all have a multidimensional relationship with the 'decision' to seek help for pain. Personality and the perceived importance of independence were found to influence these responses. The findings imply that communication between the health professional and patient needs to improve during the more comprehensive assessment of chronic pain. To achieve such improvements, it is first necessary to eradicate ageist attitudes held both by the elderly and within health care.
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Affiliation(s)
- Victoria Gammons
- Staff Nurse, Critical Care Department, Doncaster Royal Infirmary, Doncaster
| | - Glenys Caswell
- Research Fellow, School of Health Sciences, University of Nottingham
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Toye F, Seers K, Allcock N, Briggs M, Carr E, Andrews J, Barker K. A meta-ethnography of patients’ experience of chronic non-malignant musculoskeletal pain. HEALTH SERVICES AND DELIVERY RESEARCH 2013. [DOI: 10.3310/hsdr01120] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe alleviation of pain is a key aim of health care yet pain can often remain a puzzle as it is not always explained by a specific pathology. Musculoskeletal (MSK) pain is one of the most predominant kinds of chronic pain and its prevalence is increasing. One of the aims of qualitative research in health care is to understand the experience of illness, and make sense of the complex processes involved. However, the proliferation of qualitative studies can make it difficult to use this knowledge. There has been no attempt to systematically review and integrate the findings of qualitative research in order to increase our understanding of chronic MSK pain. A synthesis of qualitative research would help us to understand what it is like to have chronic MSK pain. Specifically, it would help us understand peoples' experience of health care with the aim of improving it.AimThe aim of this study was to increase our understanding of patients’ experience of chronic non-malignant MSK pain; utilise existing research knowledge to improve understanding and, thus, best practice in patient care; and contribute to the development of methods for qualitative research synthesis.MethodsWe used the methods of meta-ethnography, which aim to develop concepts that help us to understand a particular experience, by synthesising research findings. We searched six electronic bibliographic databases (including MEDLINE, EMBASE and PsycINFO) and included studies up until the final search in February 2012. We also hand-searched particular journals known to report qualitative studies and searched reference lists of all relevant qualitative studies for further potential studies. We appraised each study to decide whether or not to include it. The full texts of 321 potentially relevant studies were screened, of which 77 qualitative studies that explored adults’ experience of chronic non-malignant MSK pain were included. Twenty-eight of these studies explored the experience of fibromyalgia.ResultsOur findings revealed the new concept of an adversarial struggle that explains the experience of people with chronic MSK pain. This included the struggle to affirm self and construct self over time; find an explanation for pain; negotiate the health-care system while feeling compelled to stay in it; be valued and believed; and find the right balance between sick/well and hiding/showing pain. In spite of this struggle, our model showed that some people were able to move forward alongside their pain by listening to their body rather than fighting it; letting go of the old self and finding a new self; becoming part of a community and not feeling like the only one; telling others about pain and redefining relationships; realising that pain is here to stay rather than focusing on diagnosis and cure; and becoming the expert and making choices. We offer unique methodological innovations for meta-ethnography, which allowed us to develop a conceptual model that is grounded in 77 original studies. In particular, we describe a collaborative approach to interpreting the primary studies.ConclusionOur model helps us to understand the experience of people with chronic MSK pain as a constant adversarial struggle. This may distinguish it from other types of pain. This study opens up possibilities for therapies that aim to help a person to move forward alongside pain. Our findings call on us to challenge some of the cultural notions about illness, in particular the expectation of achieving a diagnosis and cure. Cultural expectations are deep-rooted and can deeply affect the experience of pain. We therefore should incorporate cultural categories into our understanding of pain. Not feeling believed can have an impact on a person’s participation in everyday life. The qualitative studies in this meta-ethnography revealed that people with chronic MSK pain still do not feel believed. This has clear implications for clinical practice. Our model suggests that central to the relationship between patient and practitioner is the recognition of the patient as a person whose life has been deeply changed by pain. Listening to a person’s narratives can help us to understand the impact of pain. Our model suggests that feeling valued is not simply an adjunct to the therapy, but central to it. Further conceptual syntheses would help us make qualitative research accessible to a wider relevant audience. Further primary qualitative research focusing on reconciling acceptance with moving forward with pain might help us to further understand the experience of pain. Our study highlights the need for research to explore educational strategies aimed at improving patients’ and clinicians’ experience of care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- F Toye
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Seers
- Royal College of Nursing Research Institute, School of Health and Social Studies, University of Warwick, Warwick, UK
| | - N Allcock
- Faculty of Medicine and Health Sciences, School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Nottingham, UK
| | - M Briggs
- Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
| | - E Carr
- Faculty of Nursing, University of Calgary, Alberta, Canada
| | - J Andrews
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, Knaggs R, Martin D, Sampson L, Schofield P. Guidance on the management of pain in older people. Age Ageing 2013; 42 Suppl 1:i1-57. [PMID: 23420266 DOI: 10.1093/ageing/afs200] [Citation(s) in RCA: 342] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This guidance document reviews the epidemiology and management of pain in older people via a literature review of published research. The aim of this document is to inform health professionals in any care setting who work with older adults on best practice for the management of pain and to identify where there are gaps in the evidence that require further research. The assessment of pain in older people has not been covered within this guidance and can be found in a separate document (http://www.britishpainsociety.org/pub_professional.htm#assessmentpop). Substantial differences in the population, methods and definitions used in published research makes it difficult to compare across studies and impossible to determine the definitive prevalence of pain in older people. There are inconsistencies within the literature as to whether or not pain increases or decreases in this age group, and whether this is influenced by gender. There is, however, some evidence that the prevalence of pain is higher within residential care settings. The three most common sites of pain in older people are the back; leg/knee or hip and 'other' joints. In common with the working-age population, the attitudes and beliefs of older people influence all aspects of their pain experience. Stoicism is particularly evident within this cohort of people. Evidence from the literature search suggests that paracetamol should be considered as first-line treatment for the management of both acute and persistent pain, particularly that which is of musculoskeletal origin, due to its demonstrated efficacy and good safety profile. There are few absolute contraindications and relative cautions to prescribing paracetamol. It is, however, important that the maximum daily dose (4 g/24 h) is not exceeded. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in older people after other safer treatments have not provided sufficient pain relief. The lowest dose should be provided, for the shortest duration. For older adults, an NSAID or cyclooxygenase-2 (COX-2) selective inhibitor should be co-prescribed with a proton pump inhibitor (PPI), and the one with the lowest acquisition cost should be chosen. All older people taking NSAIDs should be routinely monitored for gastrointestinal, renal and cardiovascular side effects, and drug–drug and drug–disease interactions. Opioid therapy may be considered for patients with moderate or severe pain, particularly if the pain is causing functional impairment or is reducing their quality of life. However, this must be individualised and carefully monitored. Opioid side effects including nausea and vomiting should be anticipated and suitable prophylaxis considered. Appropriate laxative therapy, such as the combination of a stool softener and a stimulant laxative, should be prescribed throughout treatment for all older people who are prescribed opioid therapy. Tricyclic antidepressants and anti-epileptic drugs have demonstrated efficacy in several types of neuropathic pain. But, tolerability and adverse effects limit their use in an older population. Intra-articular corticosteroid injections in osteoarthritis of the knee are effective in relieving pain in the short term, with little risk of complications and/or joint damage. Intra-articular hyaluronic acid is effective and free of systemic adverse effects. It should be considered in patients who are intolerant to systemic therapy. Intra-articular hyaluronic acid appears to have a slower onset of action than intra-articular steroids, but the effects seem to last longer. The current evidence for the use of epidural steroid injections in the management of sciatica is conflicting and, until further larger studies become available, no firm recommendations can be made. There is, however, a limited body of evidence to support the use of epidural injections in spinal stenosis. The literature review suggests that assistive devices are widely used and that the ownership of devices increases with age. Such devices enable older people with chronic pain to live in the community. However, they do not necessarily reduce pain and can increase pain if used incorrectly. Increasing activity by way of exercise should be considered. This should involve strengthening, flexibility, endurance and balance, along with a programme of education. Patient preference should be given serious consideration. A number of complementary therapies have been found to have some efficacy among the older population, including acupuncture, transcutaneous electrical nerve stimulation (TENS) and massage. Such approaches can affect pain and anxiety and are worth further investigation. Some psychological approaches have been found to be useful for the older population, including guided imagery, biofeedback training and relaxation. There is also some evidence supporting the use of cognitive behavioural therapy (CBT) among nursing home populations, but of course these approaches require training and time. There are many areas that require further research, including pharmacological management where approaches are often tested in younger populations and then translated across. Prevalence studies need consistency in terms of age, diagnosis and terminology, and further work needs to be done on evaluating non-pharmacological approaches.
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Moore A, Grime J, Campbell P, Richardson J. Troubling stoicism: Sociocultural influences and applications to health and illness behaviour. Health (London) 2012; 17:159-73. [DOI: 10.1177/1363459312451179] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In light of the ambiguity of meanings attributed to the concept of stoicism we critically explore its use as a label to explain and describe health and illness behaviour, juxtaposing the often negative portrayals of contemporary stoicism against its classical and philosophical origins. By reflecting critically on the term ‘stoicism’, its application and dimensionality, we show how the term has evolved from classical to contemporary times in relation to changing context, and explore different understandings of the term across medical and health literature. We attend to sociocultural factors that are seen to influence the conceptualization of stoicism such as generational influences, gender and geographies. We make the assertion that by applying the label of ‘stoicism’ as it is known today, there is a danger of too readily accepting a term that masks particular health behaviours while missing an array of sociological factors that are important to how people deal with adversity arising from chronic health problems. We therefore encourage further questioning of this term.
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Richardson C. An introduction to the biopsychosocial complexities of managing wound pain. J Wound Care 2012; 21:267-8, 270-3. [DOI: 10.12968/jowc.2012.21.6.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C. Richardson
- School of Nursing, Midwifery and Social Work, University of Manchester. UK
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Rowbotham S, Holler J, Lloyd D, Wearden A. How Do We Communicate About Pain? A Systematic Analysis of the Semantic Contribution of Co-speech Gestures in Pain-focused Conversations. JOURNAL OF NONVERBAL BEHAVIOR 2011. [DOI: 10.1007/s10919-011-0122-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schofield P, Clarke A, Jones D, Martin D, McNamee P, Smith B. Chronic pain in later life: a review of current issues and challenges. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.41] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effects of aging present a major medical challenge in the 21st century, which will cause fundamental changes in demography. By 2031, it is estimated that 22% of the UK population will be aged over 65 years, and there will be more people in this age group than aged under 25 years. As well as implications for infrastructure and productivity, this change will alter the prevalence and impact of many illnesses and pathologies. The research priorities of many of the major funding bodies reflect this challenge. The Medical Research Council in the UK, for example, leads the Lifelong Health and Wellbeing program on behalf of all the country’s research councils. This initiative aims to identify factors that affect or improve health in later life, to inform relevant policy and practice. The Wellcome Trust lists the investigation of development, aging and chronic disease as one of its five major research challenges, and the European Commission presents the health of the aging population as one of its three overarching issues of the Health Theme in its 7th Framework Program of research. Chronic pain is a major health condition associated with aging, whose management (pharmacological and nonpharmacological) is generally unsatisfactory. The International Association for the Study of Pain designated 2006/07 as its Global Year Against Pain in Older Adults. This article reviews the relevance of existing and potential research on the assessment and management of chronic pain in older adults.
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Affiliation(s)
| | - Amanda Clarke
- Centre for Advanced Studies in Nursing (CASN), Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland
| | - Derek Jones
- Northumbria University School of Health, Community & Education Studies, Room H215, Coach Lane Campus West, Newcastle upon Tyne, NE7 7XA, UK
| | - Denis Martin
- Health & Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Blair Smith
- Centre of Academic Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen, AB25 2AY, Scotland, UK
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Abstract
Pain assessment conventionally has been viewed hierarchically with self-report as its "gold-standard." Recent attempts to improve pain management have focused on the importance of assessment, for example, the initiative to include pain as the "fifth vital sign." We question the focus in the conceptualization of pain assessment upon a "vital sign," not in terms of the importance of assessment, but in terms of the application of self-report as a mechanistic index akin to a biologic measure such as heart rate and blood pressure. We synthesize current inclusive models of pain and pain assessment and propose a more comprehensive conceptualization of pain assessment as a transaction based on an organismic interplay between the patient and clinician.
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Caress A, Luker K, Chalmers K. Promoting the health of people with chronic obstructive pulmonary disease: patients' and carers' views. J Clin Nurs 2010; 19:564-73. [PMID: 20500291 DOI: 10.1111/j.1365-2702.2009.02982.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to generate in-depth insights into patients' and family members' understanding of the causation, progression and prevention of chronic obstructive pulmonary disease and the role of health promotion with this population. In particular, we were interested in identifying the ways patients and family members considered that they could maximise their (patients') health, in the presence of this disease. BACKGROUND Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is, therefore, an important consideration. There are few examples in the literature of health promotion programmes for this population, including those directed at smoking cessation, which also focus on the family or significant others. DESIGN An exploratory, descriptive design was employed. METHOD Semi-structured, audio-recorded interviews were conducted with 14 patients and 12 family caregivers. Interviews were transcribed verbatim and thematically analysed using content analysis procedures which captured the meaning of the data. RESULTS The three main themes were 'health promotion: what's that?', 'community resources for health promotion' and 'it wasn't just the smoking'. Many participants seemed unaware that their health might benefit from a healthier life style and provided little spontaneous information on any activities they carried out to maintain or improve their health. CONCLUSIONS This study highlighted a dearth of health promoting activity amongst people affected by chronic obstructive pulmonary disease. The reality for most patients was to manage the day-to-day demands that the symptoms of the disease imposed on them. Our data suggest that a more wide-ranging approach, encompassing aspects of health promotion, might be welcomed by many patients and their family carers. RELEVANCE TO CLINICAL PRACTICE The findings from this study highlight gaps in patients' and carers' understanding of the potential role of health promotion in chronic obstructive pulmonary disease and areas for intervention by health professionals. With the increase in smoking rates of women and predicted future increases in chronic obstructive pulmonary disease, it is imperative that health professionals find effective ways to provide support and health promotive care for patients and families.
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Affiliation(s)
- Ann Caress
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Yamada Y, Vass M, Hvas L, Igarashi A, Hendriksen C, Avlund K. Collaborative relationship in preventive home visits to older people. Int J Older People Nurs 2010; 6:33-40. [DOI: 10.1111/j.1748-3743.2010.00213.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sietsema WK. Standardization of pain measurements in clinical trials. Methods Mol Biol 2010; 617:483-492. [PMID: 20336443 DOI: 10.1007/978-1-60327-323-7_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Standardization of the measurement of pain in clinical trials will reduce variability, thus improving the quality of the data and reducing the number of patients needed to conduct pain trials. Standardization applies to the physical and psychosocial environment surrounding the patient, and there are many elements within this environment that can be effectively controlled. For example, the appearance of the examination room can be selected for neutrality and influences from visitors and staff can be minimized. Training is an important aspect of the standardization process and should be provided to all study staff. Staff training should first provide orientation on the protocol objectives and procedures and then a thorough discussion of the pain measures being used and how assessments will be conducted. Furthermore, as the patient is ultimately responsible for assessing his or her level of pain, it is important to train the patient to make reliable and accurate assessments of pain.
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Affiliation(s)
- William K Sietsema
- Kendle International Inc, and College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
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