Piotrowski Alexandra, Schmidt Alexandra, Seuken Natalie, Goldberg Lia, Kufeld Neele, Kersting Christine, Bencheva Veronika, Thürmann Petra, Mortsiefer Achim
General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany.
General Practice I and Interprofessional Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany.
J Pain Res. 2025 May 20;18:2567-2581. doi: 10.2147/JPR.S522497. eCollection 2025.
This study is part of the GESCO feasibility project (funded by the German Federal Ministry of Health) aimed at developing a sex- and gender-sensitive primary care intervention for patients with chronic non-cancer pain (CNCP) receiving long-term opioid therapy (LTOT). To inform the intervention design, we explored general practitioners' (GPs) experiences and needs in managing this patient group, with a particular focus on the role of sex and gender.
We conducted semi-structured telephone interviews with five GPs in Germany using a convenience sample. Interviews were transcribed verbatim and analyzed using the Rapid approach to integrate findings quickly into the broader project.
Treating patients with CNCP and LTOT is highly complex and emotionally demanding. GPs described feeling caught between patients' high expectations and their own limitations, which often strained therapeutic relationships. Gender dynamics played a key role in shaping these interactions. While male GPs emphasized neutrality, underlying gender stereotypes still influenced their behavior. Female GPs reported stronger trust with female patients, while male GPs described a greater focus on asserting control. Stigmatization-especially affecting female patients-was reported to hinder open communication and trust. GPs expressed the need for more time, better training in gender-sensitive care, and stronger interdisciplinary collaboration.
To improve care for patients with CNCP and LTOT, recommendations include: extending consultation times with adequate reimbursement, ensuring comprehensive medical histories, enhancing GP training in gender-sensitive care, improving diagnostic tools, and promoting peer collaboration. Further measures involve supporting patient self-management, empathy, and communication, as well as adopting a biopsychosocial and sex- and gender-sensitive approach to treatment.
本研究是GESCO可行性项目（由德国联邦卫生部资助）的一部分，旨在为接受长期阿片类药物治疗（LTOT）的慢性非癌性疼痛（CNCP）患者开发一种对性别敏感的初级保健干预措施。为了为干预设计提供信息，我们探讨了全科医生（GPs）在管理这一患者群体方面的经验和需求，特别关注性别角色。
我们采用便利抽样法对德国的五名全科医生进行了半结构化电话访谈。访谈内容逐字转录，并使用快速方法进行分析，以便将研究结果迅速整合到更广泛的项目中。
治疗CNCP和LTOT患者非常复杂，对情绪要求很高。全科医生表示，他们感到自己处于患者的高期望和自身局限性之间，这常常使治疗关系紧张。性别动态在塑造这些互动中起着关键作用。虽然男性全科医生强调中立，但潜在的性别刻板印象仍然影响着他们的行为。女性全科医生报告说与女性患者的信任更强，而男性全科医生则表示更注重掌控局面。据报告，污名化——尤其是对女性患者的影响——阻碍了开放沟通和信任。全科医生表示需要更多时间、更好的性别敏感护理培训以及更强有力的跨学科合作。
为改善对CNCP和LTOT患者的护理，建议包括：延长咨询时间并给予适当补偿，确保全面的病史记录，加强全科医生在性别敏感护理方面的培训，改进诊断工具，促进同行合作。进一步的措施包括支持患者自我管理、同理心和沟通，以及采用生物心理社会和对性别敏感的治疗方法。
