Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
Department of Neurosurgery (C.L.S., P.D.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
J Pain Symptom Manage. 2023 Jun;65(6):553-561. doi: 10.1016/j.jpainsymman.2023.02.007. Epub 2023 Feb 15.
Stigma is known to impact the care of patients with opioid use disorder (OUD).
This qualitative study seeks to understand how stigma is expressed in the medical chart by healthcare workers towards patients with cancer pain and OUD treated at an academic medical center.
This descriptive qualitative study utilized a thematic analysis approach to analyze the medical charts of 25 hospitalized patients with current or previous opioid use disorder and cancer with respect to their pain care in forty pain-related hospital admissions to a tertiary academic center from 2015 to 2020. The codebook utilized a well-characterized stigma framework and emerging themes were identified through an iterative, comparative method. COREQ guidelines were followed.
Evidence of stigma marking was present in the medical chart aligning with several intersecting stigmas. Drivers such as blame and stereotypes impeded pain care, while facilitators such as legal or policy influences and non-care advocates could be either positive or negative determinants to pain care. Care by known providers within the healthcare environment was largely a facilitator of improved pain care.
Healthcare provider stigma must be addressed as its effects are both quantitatively and qualitatively affecting patient care; in particular access to pain treatment. Continuity of care by known care providers may improve pain care for patients with cancer and OUD who are acutely hospitalized.
众所周知，耻辱感会影响阿片类药物使用障碍（OUD）患者的治疗。
本定性研究旨在了解医护人员在学术医疗中心治疗癌症疼痛和 OUD 患者的医疗记录中是如何表达耻辱感的。
本描述性定性研究采用主题分析方法，分析了 2015 年至 2020 年期间 25 名患有当前或既往阿片类药物使用障碍和癌症的住院患者的医疗记录，这些患者在四十次与疼痛相关的住院治疗中接受了疼痛治疗。代码簿采用了一个特征明确的耻辱感框架，并通过迭代、比较的方法确定了新出现的主题。遵循了 COREQ 指南。
医疗记录中存在耻辱标记的证据，与几种交叉耻辱感一致。责备和刻板印象等驱动因素阻碍了疼痛治疗，而法律或政策影响和非护理倡导者等促进因素可能对疼痛治疗产生积极或消极的影响。医疗保健环境中已知提供者的护理在很大程度上促进了疼痛护理的改善。
医护人员的耻辱感必须得到解决，因为它对患者护理的影响无论是在数量上还是在质量上都在影响着患者护理；特别是疼痛治疗的可及性。由已知护理提供者提供的连续性护理可能会改善急性住院的癌症和 OUD 患者的疼痛护理。
