Paul-Savoie Emilie, Bourgault Patricia, Potvin Stéphane, Gosselin Emilie, Lafrenaye Sylvie
School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Pain Res Manag. 2018 Sep 24;2018:6375713. doi: 10.1155/2018/6375713. eCollection 2018.
The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context.
A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer's assessment using a video of real patients with chronic pain.
The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler-Danlos syndrome and fibromyalgia) ( < 0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience.
The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.
采用以患者为中心的跨学科护理（PCC）和共情行为似乎是解决慢性疼痛管理问题的一条有前景的途径，但在这种情况下其应用似乎并不理想。几个患者因素会影响PCC和共情的应用，但关于疼痛可见性对这些行为的影响却知之甚少。本研究的目的是调查在慢性疼痛背景下，可见身体体征对护理人员以患者为中心和共情行为的影响。
21名护士和21名医生的便利样本参与了一项描述性研究。使用慢性疼痛真实患者的视频，通过自我评估和观察者评估对PCC和共情进行评价。
结果显示护理人员表现出个体内差异：对于有疼痛可见体征（类风湿性关节炎和复杂性区域疼痛综合征）的患者，参与者的PCC和共情行为显著高于无可见体征的患者（埃勒斯-当洛综合征和纤维肌痛）（<0.001）。根据疼痛可见性，以患者为中心行为差异较大的参与者临床经验较少。
慢性疼痛患者的疼痛可见性是促使护士和医生更多使用PCC和共情的一个重要因素，临床经验会影响他们的行为。因此，疼痛不可见可能是护理质量的一个障碍，这些发现强化了对护理人员进行教育以消除他们对慢性疼痛患者行为的这些无意识偏见的相关性。
