A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care
Abstract:Background
People with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research.
Objectives
(1) To undertake a qualitative evidence synthesis (QES) to incr… Show more
“…The CERQual assessments indicated there was a high level of confidence in the findings for managing pain, managing work relationships, managing the workplace, self-belief, health and illness representations, the meaning of work and system factors. Although we have used CERQual, we found we agreed with many comments on its use by Toye et al ,55 namely that for relevance, studies rated as partially or indirectly relevant could also contain helpful concepts. They suggest ‘gravitational pull’ of an idea may be important.…”
AimsTo understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model.DesignSynthesis of qualitative research using meta-ethnography.Data sourcesEleven bibliographic databases from inception to April 2017 supplemented by citation tracking.Review methodsWe used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument.ResultsWe included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working.ConclusionsFor people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.
“…The CERQual assessments indicated there was a high level of confidence in the findings for managing pain, managing work relationships, managing the workplace, self-belief, health and illness representations, the meaning of work and system factors. Although we have used CERQual, we found we agreed with many comments on its use by Toye et al ,55 namely that for relevance, studies rated as partially or indirectly relevant could also contain helpful concepts. They suggest ‘gravitational pull’ of an idea may be important.…”
AimsTo understand obstacles to returning to work, as perceived by people with chronic non-malignant pain and as perceived by employers, and to develop a conceptual model.DesignSynthesis of qualitative research using meta-ethnography.Data sourcesEleven bibliographic databases from inception to April 2017 supplemented by citation tracking.Review methodsWe used the methods of meta-ethnography. We identified concepts and conceptual categories, and developed a conceptual model and line of argument.ResultsWe included 41 studies. We identified three core categories in the conceptual model: managing pain, managing work relationships and making workplace adjustments. All were influenced by societal expectations in relation to work, self (self-belief, self-efficacy, legitimacy, autonomy and the meaning of work for the individual), health/illness/pain representations, prereturn to work support and rehabilitation, and system factors (healthcare, workplace and social security). A mismatch of expectations between the individual with pain and the workplace contributed to a feeling of being judged and difficulties asking for help. The ability to navigate obstacles and negotiate change underpinned mastering return to work despite the pain. Where this ability was not apparent, there could be a downward spiral resulting in not working.ConclusionsFor people with chronic pain, and for their employers, navigating obstacles to return to work entails balancing the needs of (1) the person with chronic pain, (2) work colleagues and (3) the employing organisation. Managing pain, managing work relationships and making workplace adjustments appear to be central, but not straightforward, and require substantial effort to culminate in a successful return to work.
“…We used subject headings and free text terms for qualitative research, combined with subject heading and free text terms for incontinence (Table 1). Our search terms were adapted from the InterTASC Information Specialists' Sub-Group (ISSG) Search Filter Resources [27][28][29][30] and have been used in other metaethnographies [7,31,32] We excluded studies that exclusively explored: peri-partum, neurological, faecal, long-term care, acute hospitalisation, pelvic organ prolapse and incontinence surgery. In their original text, Noblit and Hare do not advocate an exhaustive search [6] and the number of studies included in metaethnographies ranges [16,18,33].…”
Section: Deciding What Is Relevant (Stage 2)mentioning
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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