Experiences of Pediatric Pain Professionals Providing Care during the COVID-19 Pandemic: A Qualitative Study

Abstract

Chronic pain affects 1 in 5 youth, many of whom manage their pain using a biopsychosocial approach. The COVID-19 pandemic has impacted the way that healthcare is delivered. As part of a larger program of research, this study aimed to understand the impact of the pandemic on pediatric chronic pain care delivery including impact on patients’ outcomes, from the perspective of pediatric healthcare providers. A qualitative descriptive study design was used and 21 healthcare providers from various professional roles, clinical settings, and geographic locations across Canada were interviewed. Using a reflexive thematic analysis approach 3 themes were developed: (1) duality of pandemic impact on youth with chronic pain (i.e., how the pandemic influenced self-management while also exacerbating existing socioeconomic inequalities); (2) changes to the healthcare system and clinical practices (i.e., triaging and access to care); (3) shift to virtual care (i.e., role of institutions and hybrid models of care). These findings outline provider perspectives on the positive and negative impacts of the pandemic on youth with chronic pain and highlight the role of socioeconomic status and access to care in relation to chronic pain management during the pandemic in a high-income country with a publicly funded healthcare system.

“Working Together”: Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic

“…Particularly, medicine and rehabilitation professionals indicated that the lack of hands-on physical examination made virtual assessment more challenging. These findings align with other studies, which described the challenges of performing physical exams and the absence of nonverbal cues as being HCP-reported limitations of virtual care [ 17 , 35 ]. Further examinations of HCPs’ experiences highlighted that professionals in the mental health field experienced increased comfort discussing sensitive topics (e.g., self-injury) virtually than those in medicine or rehabilitation.…”

“…Further, given that the optimal paradigm for chronic pain management involves psychological, physical, and pharmacological approaches, the transition from in-person care to a full-scale virtual model was no easy feat [ 15 , 16 ]. Multidisciplinary treatment (MDT) teams consisting of physicians (e.g., anesthesiologist, pain doctor, or pediatrician), physical therapists, nurse practitioners, psychologists and/or psychiatrists, occupational therapists, and/or social workers began to rapidly navigate virtual technology to ensure that patients received safe and quality care [ 13 , 17 ]. While some HCPs had prior knowledge of and practice delivering occasional telemedicine appointments, very few had experience delivering full-time remote services (e.g., videoconference, telephone consultation) [ 12 , 18 , 19 ].…”

“…While some HCPs had prior knowledge of and practice delivering occasional telemedicine appointments, very few had experience delivering full-time remote services (e.g., videoconference, telephone consultation) [ 12 , 18 , 19 ]. HCPs faced many administrative, logistical (i.e., infrastructure, setting up virtual care), and technological (i.e., internet connection, technological literacy) challenges, but they demonstrated resilience in meeting the demands of the unprecedented circumstances [ 13 , 17 ].…”

“…When considering specifically the delivery of virtual pediatric pain care, HCPs described the inability to perform in-person physical exams, the blunting of nonverbal and physical cues, and inequitable access to the internet and technological devices as major limitations. These findings come from an investigation by Killackey et al [ 17 ], who conducted a qualitative analysis of various HCPs’ experiences in shifting to virtual pediatric pain care during the pandemic. The present study aims to build on these findings and enhance the understanding of providing this care in the context of an MDT team.…”

“We survived the pandemic together”: The impact of the COVID-19 pandemic on Canadian families living with chronic pain

“…is a clinical research project coordinator who was trained in qualitative interviewing and supervised by the lead author. A semistructured interview guide was developed based on previous pandemic impact work 39 and parallel qualitative work being completed with health care professionals who care for youth with chronic pain 40 (see Supplementary Materials for the youth, sibling, and parent interview guides). The guides were based on key concepts from the family adjustment and adaptation response model 35 (further described below) and focused on exploring youth and family member experiences throughout the COVID-19 pandemic and the impact on their pain, coping, and family life.…”