对初级保健医疗专业人员在接受简短疼痛科学教育后对疼痛及疼痛管理的理解的探索。
An exploration of primary care healthcare professionals' understanding of pain and pain management following a brief pain science education.
作者信息
Mankelow Jagjit, Ryan Cormac G, Green Paul W, Taylor Paul C, Martin Denis
机构信息
School of Health and Life Sciences, Centuria Building, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, England.
Linthorpe Surgery, 378 Linthorpe Road, Middlesbrough, TS5 6HA, England.
出版信息
BMC Med Educ. 2022 Mar 28;22(1):211. doi: 10.1186/s12909-022-03265-2.
BACKGROUND
Persistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this.
PURPOSE OF THE STUDY
- Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE).
METHODS
An exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention.
RESULTS
Clinicians' relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients' passive and often oppositional biomedical treatment expectations; and clinicians' lack of readily understandable language to communicate with patients.
CONCLUSION
The findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles.
TRIAL REGISTRATION
This study was prospectively registered at ClinicalTrials.Gov ( NCT04587596 ) in October 2020.
背景
持续性疼痛是全球致残的主要原因，然而，在临床实践中实施推荐生物心理社会方法的临床指南仍然是一项挑战。临床医生对疼痛的理解有限可能是部分原因。
研究目的
1）定性探索在常规临床实践中接受疼痛科学教育（PSE）的经历、对PSE的理解以及PSE相关原则的实施情况。2）定量探索全科医生（GPs）和执业护士（NPs）在接受疼痛科学教育（PSE）前后的疼痛知识、态度和行为。
方法
在英格兰东北部进行的一项探索性、单中心、混合方法研究。15名全科医生/执业护士在参加70分钟的面对面PSE讲座前后完成问卷和病例 vignette。干预后，从两个焦点小组对定性数据进行了主题分析。
结果
临床医生之前相对较高的知识、态度和行为水平在接受PSE后相似。定性主题描述了对疼痛管理行为自我反思的促进，以及在实践中实施PSE原则的困难，包括：与患者的融洽关系有限；预约时间短；患者被动且往往对立的生物医学治疗期望；以及临床医生缺乏易于理解的语言与患者沟通。
结论
研究结果突出了这些已经倾向于生物心理社会疼痛管理的临床医生所认识到的PSE的价值。他们寻求更多个人学习资源以及与患者沟通的资源。即使有这种积极的倾向，临床实践的实际情况和环境也阻碍了PSE相关原则的实施。
试验注册
本研究于2020年10月在ClinicalTrials.Gov（NCT04587596）进行了前瞻性注册。
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