College of Nursing, Korea University, Seoul, South Korea; Institute of Nursing Research, Korea University, Seoul, South Korea; Transdisciplinary Major in Learning Health Systems, Korea University, Seoul, South Korea.
School of Nursing, University of Connecticut, Storrs, Connecticut; Center for Advancement in Managing Pain, University of Connecticut, Storrs, Connecticut.
Pain Manag Nurs. 2021 Aug;22(4):470-477. doi: 10.1016/j.pmn.2021.02.003. Epub 2021 Mar 18.
Fifty million American adults have chronic pain, and nearly 20 million have high-impact, or disabling, chronic pain, with higher prevalence associated with advancing age. Patient-centered pain management has been cited as a national priority to ensure that patient values and preferences guide clinical decisions. However, explicit, and practical strategies for implementing patient-centered pain management have not been disseminated.
The aim of this study was to elicit perceptions, beliefs, and experiences of patient-centered pain management among adults with chronic pain as well as among providers that could be used to develop recommendations for implementation and evaluation of patient-centered pain management.
A descriptive qualitative study.
SETTINGS/PARTICIPANTS: Fourteen adults with chronic pain were recruited from the communities. Besides, five providers caring for patients with chronic pain at an outpatient spine center affiliated to one academic hospital joined this study.
Each focus group lasted about 1 hour, which was recorded and transcribed verbatim. Data were analyzed using Erlingsson and Brysiewicz's content analysis to identify themes and develop recommendations.
Four overarching themes emerged, including: (1) patient and (2) provider characteristics affecting patient-centered pain management; (3) processes and (4) outcomes of patient-centered pain management. We also visually depicted the determinants, processes, and outcomes of patient-centered pain management among providers and individuals with chronic pain.
Patients emphasized their desire for a provider that listens, genuinely cares, and sees them holistically to provide the best individual and tailored care for them. Providers focused on setting realistic expectations, vocalizing the significance of pain education at a young age, and balancing patient satisfaction and opioid prescriptions. While patients can be empowered to self-manage their chronic pain due to patient-centered pain care, provider mental exhaustion and mistrust of providers among patients resulted from suboptimal pain management.
五千万美国成年人患有慢性疼痛，近两千万人患有高影响或致残性慢性疼痛，且随着年龄的增长，患病率呈上升趋势。以患者为中心的疼痛管理已被提为国家重点，以确保患者的价值观和偏好指导临床决策。然而，尚未推广实施以患者为中心的疼痛管理的明确且实用的策略。
本研究旨在了解患有慢性疼痛的成年人以及为慢性疼痛患者提供护理的医护人员对以患者为中心的疼痛管理的看法、信念和经验，以便为实施和评估以患者为中心的疼痛管理提出建议。
描述性定性研究。
地点/参与者： 从社区招募了 14 名患有慢性疼痛的成年人。此外，从一家学术医院附属的门诊脊柱中心招募了五名护理慢性疼痛患者的医护人员参与了这项研究。
每个焦点小组持续约 1 小时，全程录音并逐字记录。使用 Erlingsson 和 Brysiewicz 的内容分析法分析数据，以确定主题并提出建议。
出现了四个总体主题，包括：（1）影响以患者为中心的疼痛管理的患者和（2）提供者特征；（3）以患者为中心的疼痛管理的过程和（4）结果。我们还以图表形式描绘了提供者和慢性疼痛患者的以患者为中心的疼痛管理的决定因素、过程和结果。
患者强调他们希望得到一位倾听、真心关怀并全面看待他们的提供者，以提供最适合个人和量身定制的护理。医护人员则专注于设定现实的期望，强调年轻时进行疼痛教育的重要性，以及平衡患者满意度和阿片类药物处方。虽然通过以患者为中心的疼痛护理可以增强患者自我管理慢性疼痛的能力，但由于疼痛管理效果不佳，导致医护人员感到精疲力竭和患者对医护人员失去信任。
