Centre for Pain Research, National University of Ireland, Galway, Ireland; School of Psychology, National University of Ireland, Galway, Ireland.
Centre for Pain Research, National University of Ireland, Galway, Ireland.
Pain Physician. 2017 Sep;20(6):E951-E960.
Though there is wide support for the application of biopsychosocial perspectives in clinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequate training or attitudes favoring a biomedical approach. Recent research has indicated that despite such explanations, both established general practitioners (GP) and medical students account for some psychosocial factors when making clinical judgements regarding chronic pain cases, but report not being likely to apply these in real-world, clinical settings due to numerous factors, including available time with patients. Thus, it is evident that a greater understanding of clinical judgement-making processes and the factors that affect application of these processes is required, particularly regarding chronic pain.
The aims of the current study were to investigate medical students' conceptualizations of the factors that influence application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain using interactive management (IM), model the relationships among these factors, and make recommendations to chronic pain treatment policy in light of the findings.
The current study used IM to identify and model factors that influence the application of a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medical students' conceptualizations of these factors.
Two university classrooms.
IM is a systems thinking and action mapping strategy used to aid groups in developing outcomes regarding complex issues, through integrating contributions from individuals with diverse views, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretive structural modeling, which in this context were employed to help medical students identify, clarify, and model influences on the application of biopsychosocial perspectives in treating chronic pain patients.
Results of IM group work revealed 7 core biopsychosocial approach application categories: GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patient perception. GP attitudes was the most critical driver of all other competencies in the system, with cost and GP knowledge revealed as secondary drivers.
Potential differences in level of prior biopsychosocial perspective knowledge across participants and a potentially small sample size (though consistent with past research and appropriate for an exploratory study of this nature - for purposes of achieving the depth and richness of the deliberation and qualitative insights revealed by participants using the IM methodology).
Results from this study may be used to both recommend further research on the identified factors influencing application of biopsychosocial perspectives in treatment of chronic pain and support amendment to extant health care policy, particularly with respect to cost, GP attitudes, and knowledge. Though this research claims neither that the influences identified are the only influences on biopsychosocial application, nor the order of their importance, the research does contribute to an on-going effort to better understand the factors that influence doctors in their treatment of chronic pain.Key words: Chronic pain, biopsychosocial, medical education, clinical judgement, interactive management, pain management.
尽管在慢性疼痛病例的临床判断中广泛支持应用心理社会生物医学观点，但由于培训不足或倾向于生物医学方法的态度，这些观点常常被忽视。最近的研究表明，尽管有这些解释，经验丰富的全科医生和医学生在对慢性疼痛病例进行临床判断时都会考虑一些心理社会因素，但由于许多因素，包括与患者相处的时间有限，他们报告不太可能在实际的临床环境中应用这些因素。因此，显然需要更好地了解临床判断决策过程以及影响这些过程应用的因素，特别是对于慢性疼痛。
本研究的目的是使用互动管理（IM）调查医学生对影响慢性疼痛病例心理社会生物医学方法应用的因素的概念化，建立这些因素之间的关系，并根据研究结果为慢性疼痛治疗政策提出建议。
本研究使用 IM 根据医学生对这些因素的概念化，确定和建模影响慢性疼痛病例心理社会生物医学方法应用的因素。
两个大学教室。
IM 是一种系统思维和行动映射策略，用于通过整合来自具有不同观点、背景和视角的个人的贡献，帮助小组针对复杂问题制定结果。IM 通常使用名义群体技术和解释性结构建模，在这种情况下，这些技术用于帮助医学生确定、澄清和建模影响治疗慢性疼痛患者的心理社会生物医学观点的应用。
IM 小组工作的结果揭示了 7 个核心心理社会生物医学方法应用类别：全科医生态度、成本、全科医生知识、时间、医患关系、生物医学因素和患者感知。全科医生态度是系统中所有其他能力的最关键驱动因素，成本和全科医生知识被揭示为次要驱动因素。
参与者之间可能存在先前心理社会生物医学观点知识水平的差异，以及样本量可能较小（尽管与过去的研究一致，并且适合于此类探索性研究——目的是达到参与者使用 IM 方法所揭示的讨论的深度和丰富性以及定性见解）。
本研究的结果可用于建议进一步研究影响治疗慢性疼痛的心理社会生物医学观点应用的因素，并支持对现有医疗保健政策进行修正，特别是在成本、全科医生态度和知识方面。尽管这项研究既不声称所确定的影响是影响心理社会应用的唯一影响，也不声称它们的重要性顺序，但它确实有助于更好地理解影响医生治疗慢性疼痛的因素。关键词：慢性疼痛、心理社会生物医学、医学教育、临床判断、互动管理、疼痛管理。
