“Listen to me, learn from me”: a priority setting partnership for shaping interdisciplinary pain training to strengthen chronic pain care

Slater, Helen; Jordan, Joanne E; O’Sullivan, Peter; Schütze, Robert; Goucke, Roger; Chua, Jason; Slater, Helen; Horgan, Ben; Morgan, Simone De; Briggs, Andrew M.

doi:10.1097/j.pain.0000000000002647

Cited by 22 publications

(17 citation statements)

References 71 publications

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“…They suggested that the messages provided by pain education should be consistent between practitioners and across the community to reduce uncertainty and confusion for patients about the best management approach (Schneiderhan et al 2017). GP education was seen as vital by participants in this study, aligning with the recommendations of the Australian National Strategic Action Plan for Pain Management, which identifies clinician education as a priority (Slater et al 2022).…”

Section: Discussionmentioning

confidence: 72%

Chronic non-cancer pain management – insights from Australian general practitioners: a qualitative descriptive study

Gilkes

Bulsara

Mavaddat

2023

Aust. J. Prim. Health

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Background. The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved. Methods. The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45-60 min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively. Results. Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidencebased approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP. Conclusions. Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community.

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Section: Discussionmentioning

confidence: 72%

Chronic non-cancer pain management – insights from Australian general practitioners: a qualitative descriptive study

Gilkes

Bulsara

Mavaddat

2023

Aust. J. Prim. Health

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“…Similar priorities have been seen in paediatric chronic pain research and general chronic pain care. 3,32 The least used intervention in our study was the interdisciplinary intervention. From previous priority setting partnership studies, it is known that an increased focus on improving interdisciplinary care is warranted across both the broad domain of chronic MSK pain, common hand and wrist conditions, fractures of the lower limb, and knee arthroplasty.…”

Section: Comparison With Priority Setting Partnershipsmentioning

confidence: 99%

What is known and what is still unknown within chronic musculoskeletal pain? A systematic evidence and gap map

Lyng

Djurtoft

Bruun

et al. 2023

Pain

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Evidence and gap maps (EGMs) can be used to identify gaps within specific research areas and help guide future research agendas and directions. Currently, there are no EGMs within the broad domain of chronic musculoskeletal (MSK) pain in adults. The aim of this study was to create a contemporary EGM of interventions and outcomes used for research investigating chronic MSK pain. This EGM was based on systematic reviews of interventions published in scientific journals within the past 20 years. Embase, PubMed, the Cochrane Library, and PsycINFO were used to retrieve studies for inclusion. The quality of the included reviews was assessed using AMSTAR-II. Interventions were categorised as either physical, psychological, pharmacological, education/advice, interdisciplinary, or others. Outcomes were categorised using the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Of 4299 systematic reviews, 457 were included. Of these, 50% were rated critically low quality, 25% low quality, 10% moderate quality, and 15% rated high quality. Physical interventions (eg, exercise therapy) and education were the most common interventions reported in 80% and 20% of the studies, respectively. Pain (97%) and physical functioning (87%) were the most reported outcomes in the systematic reviews. Few systematic reviews used interdisciplinary interventions (3%) and economic-related outcomes (2%). This contemporary EGM revealed a low proportion of high-quality evidence within chronic MSK pain. This EGM clearly outlines the lack of high-quality research and the need for increased focus on interventions encompassing the entire biopsychosocial perspective.

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“…Clinicians may intentionally avoid discussing mental health owing to a lack of training and practice (feelings of inadequacy), discomfort with mental health topics, and fear of offending the patient, among other reasons [3,28,32,42,45]. Although some patients may misinterpret a musculoskeletal specialist's intentions when a discussion about thoughts and feelings is raised, there is some evidence that most people welcome it and may feel the lack of it [12,14,34]. A few bad experiences might skew surgeon behavior toward not addressing unhelpful thinking and feelings of worry or despair.…”

Section: Rationalementioning

confidence: 99%

Does Addressing Mental Health During a Musculoskeletal Specialty Care Visit Affect Patient-rated Clinician Empathy?

Ngoue

Lam

Pierson

et al. 2022

Clin Orthop Relat Res

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BackgroundUnhelpful thoughts and feelings of worry or despair about symptoms account for a notable amount of the variation in musculoskeletal symptom intensity. Specialists may be best positioned to diagnose these treatable aspects of musculoskeletal illness. Musculoskeletal specialists might be concerned that addressing mental health could offend the patient, and avoidance might delay mental health diagnosis and treatment. Evidence that conversations about mental health are not associated with diminished patient experience might increase specialist confidence in the timely diagnosis and initial motivation to treat unhelpful thoughts and feelings of worry or despair.Questions/purposesUsing transcripts of videotaped and audiotaped specialty care visits in which at least one instance of patient language indicating an unhelpful thought about symptoms or feelings of worry or despair surfaced, we asked: (1) Is clinician discussion of mental health associated with lower patient-rated clinician empathy, accounting for other factors? (2) Are clinician discussions of mental health associated with patient demographics, patient mental health measures, or specific clinicians?MethodsUsing a database of transcripts of 212 patients that were audio or video recorded for prior studies, we identified 144 transcripts in which language reflecting either an unhelpful thought or feelings of distress (worry or despair) about symptoms was detected. These were labeled mental health opportunities. Patients were invited on days when the researcher making video or audio records was available, and people were invited based on the researcher’s availability, the patient’s cognitive ability, and whether the patient spoke English. Exclusions were not tracked in those original studies, but few patients declined. There were 80 women and 64 men, with a mean age of 45 ± 15 years. Participants completed measures of health anxiety, catastrophic thinking, symptoms of depression, and perceived clinician empathy. Factors associated with perceived clinician empathy and clinician discussion of mental health were sought in bivariate and multivariable analyses.ResultsGreater patient-rated clinician empathy was not associated with clinician initiation of a mental health discussion (regression coefficient 0.98 [95% confidence interval 0.89 to 1.1]; p = 0.65). A clinician-initiated mental health discussion was not associated with any factors.ConclusionThe observation that a clinician-initiated mental health discussion was not associated with diminished patient ratings of clinician empathy and was independent from other factors indicates that generally, discussion of mental health does not harm patient-clinician relationship. Musculoskeletal clinicians could be the first to notice disproportionate symptoms or misconceptions and distress about symptoms, and based on the evidence from this study, they can be confident about initiating a discussion about these mental health priorities to avoid delays in diagnosis and treatment. Future studies can address the...

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“Listen to me, learn from me”: a priority setting partnership for shaping interdisciplinary pain training to strengthen chronic pain care

Abstract: Supplemental Digital Content is Available in the Text.This empirically derived framework strongly repositions shaping of health workforce training through a genuine partnership lens, strengthening training efforts to support high-quality, person-centred, chronic pain care.

Cited by 22 publications

References 71 publications

Chronic non-cancer pain management – insights from Australian general practitioners: a qualitative descriptive study

Chronic non-cancer pain management – insights from Australian general practitioners: a qualitative descriptive study

What is known and what is still unknown within chronic musculoskeletal pain? A systematic evidence and gap map

Does Addressing Mental Health During a Musculoskeletal Specialty Care Visit Affect Patient-rated Clinician Empathy?

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