Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
BMJ Open. 2017 Dec 21;7(12):e018411. doi: 10.1136/bmjopen-2017-018411.
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.
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.
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.
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.
通过开展定性证据综合研究，探索医疗保健专业人员治疗慢性非恶性疼痛的经验。从医疗保健专业人员的角度了解这种经验，将有助于改善护理服务。
使用元人种学法进行定性证据综合研究。我们从建库开始至 2016 年 11 月检索了 5 个电子文献数据库。我们纳入了探索医疗保健专业人员治疗慢性非恶性疼痛成年患者经验的研究。我们使用 GRADE-CERQual 框架来评估综述结果的确信度。
我们筛选了 954 篇摘要和 184 篇全文，纳入了 77 项发表的研究，共报告了超过 1551 名国际医疗保健专业人员的经验，包括医生、护士和其他卫生专业人员。我们提取了 6 个主题：（1）怀疑的文化视角；（2）同时采用医学模型；（3）在医患之间的地理环境中穿行；（4）双重主张的挑战；（5）个人代价；（6）疼痛管理的技巧。我们将综述结果的确信度评定为中等到高度。
这是第一项关于医疗保健专业人员治疗慢性非恶性疼痛患者经验的定性证据综合研究。我们提出了一个模型，帮助医疗保健专业人员理解、思考和改变他们治疗慢性疼痛患者的经验。我们的研究结果突显了对慢性疼痛的怀疑，这可能解释了为什么患者觉得自己不被信任。研究结果还表明，在生物心理社会模式中存在二元论，以及在治疗关系中穿行的复杂性。我们的模型可能适用于其他患者群体或情况。
