A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain

Toye, Francine; Seers, Kate; Hannink, Erin; Barker, Karen

doi:10.1186/s12874-017-0392-7

Cited by 80 publications

(122 citation statements)

References 54 publications

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“…It would be useful for HCPs to consider their individual mix and contemplate a re-mix if necessary in order to successfully support people with chronic pain. Now we have a body of qualitative knowledge exploring patients’ experiences of chronic pain 9 and HCPs’ experiences; the next challenge in practice is to bring these two bodies of knowledge together and look at how HCPs and patients can work together in managing pain.…”

Section: Discussionmentioning

confidence: 99%

“…A recent synthesis of 11 QES has highlighted the personal challenge of living with chronic non-malignant pain and the loss of personal credibility that is integral to this experience. 9 Findings from a QES of 77 qualitative studies exploring patients experience of living with chronic non-malignant pain also demonstrate that patients can experience healthcare as an adversarial battle. 10 Understanding this from the perspective of HCPs will help us to unpick this experience and thus contribute to improvements in care provision.…”

Section: Introductionmentioning

confidence: 99%

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Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain

2017

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ObjectivesWe aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care.DesignQualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings.ResultsWe screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high.ConclusionsThis is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain

2017

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“…We planned to develop a line of argument synthesis, and thus make 'a whole into something more than the parts alone imply' [6] (page 28). We first identified any existing QES, using search terms developed for this purpose [20,21]. We identified three QES that explored specific areas of UI: French and colleagues explored the uptake and delivery of behavioural interventions for UI (6 studies) [22]; Hay-Smith and colleagues explore the adherence to PFMT (13 studies) [23]; Avery and colleagues explored the psychosocial aspects of living with UI (10 studies) [24].…”

Section: Selecting Meta-ethnography and Getting Started (Stage 1)mentioning

confidence: 99%

“…Once we had a list of second order concepts, two reviewers 'translated' [6] these by comparing similarities and differences and gradually organising them into conceptual categories. The aim of constant comparison is to distil 'the essence of an idea' [20]. This process of abstraction is integral to qualitative analysis [40].…”

Section: Electronic Sources Medlinementioning

confidence: 99%

A meta-ethnography to understand the experience of living with urinary incontinence: ‘is it just part and parcel of life?’

Toye

Barker

2020

BMC Urol

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Background: Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare. Methods: We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings.Results: We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment. Conclusions:The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.

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“…Reviews, syntheses and meta syntheses can be found in diagnosis related groups i.e. such as low back pain (Bunzli, Watkins, Smith, Schutze, & O'Sullivan, 2013;Froud et al, 2014;MacNeela, Doyle, O'Gorman, Ruane, & McGuire, 2015;, fibromyalgia (Sim & Madden, 2008) and in long-term musculoskeletal pain conditions (Crowe et al, 2017;Löfgren, Schüldt Ekholm, Schult, & Ekholm, 2016;Osborn & Rodham, 2010;Toye et al, 2013;Toye, Seers, Hannink, & Barker, 2017).…”

Section: The Patients' Experience Of Long-term Painmentioning

confidence: 99%

Meanings of “acceptance” for patients with long-term pain when starting rehabilitation

Biguet

Wikmar

Bullington

et al. 2015

Disability and Rehabilitation

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Healthcare professionals should be aware that individuals with long-term pain conceptualize and hold different meanings of acceptance when starting rehabilitation; this should be considered and addressed in rehabilitation programmes. The meaning given to acceptance is related to the experience of the lived body and the sense of self, as well as to getting legitimization/acceptance by others; therefore these aspects need to be considered during rehabilitation. The process of achieving acceptance seems to embrace different processes which can be understood as, and facilitated by, an embodied learning process. The bodily existential challenges presented in the present study, for example to develop an integrated and cooperative relationship with the painful body, can inspire health professionals to develop interventions and communication strategies focusing on the lived body. A wide range of competencies in rehabilitation clinics seems to be needed.

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A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain

Cited by 80 publications

References 54 publications

Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain

Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain

A meta-ethnography to understand the experience of living with urinary incontinence: ‘is it just part and parcel of life?’

Meanings of “acceptance” for patients with long-term pain when starting rehabilitation

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