Balbale Salva N, Iroz Cassandra B, Schäfer Willemijn L A, Johnson Julie K, Stulberg Jonah J
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Center for Health Services and Outcomes Research, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Crohns Colitis 360. 2022 Sep 8;4(3):otac033. doi: 10.1093/crocol/otac033. eCollection 2022 Jul.
Recent data have shown high rates of opioid misuse among inflammatory bowel disease (IBD) patients. We conducted a qualitative study to explore IBD patient and provider perceptions and experiences with pain management and opioid prescribing.
We conducted a focus group with IBD patients and semistructured interviews with IBD-focused physicians and nurses. We used an inductive approach for analysis and the constant comparison method to develop and refine codes and identify prominent themes. We analyzed interview and focus group data concurrently to triangulate themes.
Nine patients and 10 providers participated. We grouped themes into 3 categories: (1) current practices to manage pain; (2) perceived pain management challenges; and (3) suggestions to optimize pain management. In the first category (current practices), both patients and providers reported building long-term patient-provider relationships and the importance of exploring nonpharmacologic pain management strategies. Patients reported proactively trying remedies infrequently recommended by IBD providers. In the second category (pain management challenges), patients and providers reported concerns about opioid use and having limited options to treat pain safely. Patients discussed chronic pain and having few solutions to manage it. In the third category, providers shared suggestions for improvement such as increasing use of nonpharmacologic pain management strategies and enhancing care coordination.
Despite some common themes between the 2 groups, we identified some pain management needs (eg, addressing chronic pain) that matter to patients but were seldom discussed by IBD providers. Addressing these areas of potential disconnect is essential to optimize pain management safety in IBD care.
近期数据显示,炎症性肠病(IBD)患者中阿片类药物滥用率很高。我们开展了一项定性研究,以探究IBD患者及医护人员对疼痛管理和阿片类药物处方的看法与经历。
我们对IBD患者进行了焦点小组访谈,并对专注于IBD治疗的医生和护士进行了半结构化访谈。我们采用归纳法进行分析,并使用持续比较法来制定和完善编码,以及识别突出主题。我们同时分析访谈和焦点小组数据,以验证主题。
9名患者和10名医护人员参与了研究。我们将主题分为3类:(1)当前的疼痛管理做法;(2)感知到的疼痛管理挑战;(3)优化疼痛管理的建议。在第一类(当前做法)中,患者和医护人员均报告称建立长期的医患关系以及探索非药物疼痛管理策略很重要。患者报告称会主动尝试IBD医护人员很少推荐的疗法。在第二类(疼痛管理挑战)中,患者和医护人员报告了对阿片类药物使用的担忧以及安全治疗疼痛的选择有限。患者讨论了慢性疼痛以及应对慢性疼痛的解决方案很少。在第三类中,医护人员分享了改进建议,如增加非药物疼痛管理策略的使用以及加强护理协调。
尽管两组之间存在一些共同主题,但我们确定了一些对患者很重要但IBD医护人员很少讨论的疼痛管理需求(如应对慢性疼痛)。解决这些潜在脱节的领域对于优化IBD护理中的疼痛管理安全性至关重要。