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

Toye, Francine; Seers, Kate; Barker, Karen

doi:10.1136/bmjopen-2017-018411

Cited by 51 publications

(38 citation statements)

References 211 publications

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“…This is not surprising as patients rely on their healthcare professionals to prescribe opioids. This finding resonates with qualitative evidence syntheses exploring the experience of patients13 and healthcare professionals 35. It seems clear that joint decision making is important for appropriate healthcare; however, our findings suggest that there are instances of mistrust on both sides.…”

Section: Discussionsupporting

confidence: 83%

“…We used search terms, free text and medical subject headings (MeSH) terms for all opioid drugs as well as their generic names. We combined these with the MeSH term ‘pain’ and a wide range of MeSH terms and words to describe all types of qualitative research and its analysis based on a search used by Toye et al in 2017 13. The search was limited to those in English and on humans, with no cut-off date.…”

Section: Methodsmentioning

confidence: 99%

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Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

et al. 2020

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ObjectiveTo review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them.DesignThis is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography.Data sources and eligibility criteriaWe searched selected databases—Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)—for qualitative studies which provide patients’ views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018).Data extraction and synthesisPapers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument.ResultsWe screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of ‘constantly balancing’ emerged from the data.ConclusionsPeople taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always ‘on the same page’ as their healthcare professional and felt changes in opioid use were often challenging.Trial registration number49470934; Pre-results.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

et al. 2020

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“…While critical appraisal has come to be an expected element of qualitative‐evidence synthesis, it is contentious because of the epistemological variety of qualitative research, the diversity of appraisal tools, the variability in ratings within as well as between tools (Carroll & Booth, ; Dixon‐Woods et al, ), and the fact that such tools do not measure conceptual quality (Toye, Seers, & Barker, ). Applying the CASP checklist for qualitative studies to mixed‐methods studies is problematic because the latter should be evaluated as a whole, given that the strengths of one strand can compensate for deficiencies of the other (Heyvaert, Hannes, Maes, & Onghena, ).…”

Section: Discussionmentioning

confidence: 99%

The lived experience of working with people with eating disorders: A meta‐ethnography

Graham

Tierney

Chisholm

et al. 2020

Intl J Eating Disorders

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Objective Working with people with eating disorders (EDs) is known to elicit strong emotional reactions, and the therapeutic alliance has been shown to affect outcomes with this clinical population. As a consequence, it is important to understand healthcare professionals' (HCPs') experiences of working with this client group. Method A meta‐synthesis was conducted of qualitative research on HCPs' lived experiences of working with people with EDs. The results from the identified studies were analyzed using Noblit and Hare's meta‐ethnographic method. Data were synthesized using reciprocal translation, and a line of argument was developed. Results Thirty‐seven studies met the inclusion criteria. Reciprocal translation resulted in a key concept: “Coping with caring without curing.” This was underpinned by the following third‐order concepts: (a) “The dissonance and discomfort of being a helper struggling to help,” (b) “Defending against the dissonance,” and (c) “Accepting the dissonance to provide safe and compassionate care.” These concepts were used to develop a line‐of‐argument synthesis, which was expressed as a new model for understanding HCPs' experiences of working with people who have an ED. Discussion Although the conflict associated with being a helper struggling to help led some HCPs to avoid and blame people with EDs, others adopted a compassionate stance characterized by humanity, humility, balance, and awareness.

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“…Ambiguity in this area raises important challenges for people assessing pain. For instance, when faced with discrepancies across different forms of assessment, clinicians report uncertainty in trying to decide which of their assessment findings should be relied upon as indicators for the nonobservable pain experience 12–16. Although there is preliminary consensus among leaders in brain imaging research that self-reports of pain should be prioritized over physiological measures,17 there is still a lack of clarity in what this means for clinical practice and research.…”

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confidence: 99%

The Multimodal Assessment Model of Pain

Wideman¹,

Edwards

Walton

et al. 2019

The Clinical Journal of Pain

104

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Objectives: Pain assessment is enigmatic. Although clinicians and researchers must rely upon observations to evaluate pain, the personal experience of pain is fundamentally unobservable. This raises the question of how the inherent subjectivity of pain can and should be integrated within assessment. Current models fail to tackle key facets of this problem, such as what essential aspects of pain are overlooked when we only rely on numeric forms of assessment, and what types of assessment need to be prioritized to ensure alignment with our conceptualization of pain as a subjective experience. We present the multimodal assessment model of pain (MAP) as offering practical frameworks for navigating these challenges. Methods: This is a narrative review. Results: MAP delineates qualitative (words, behaviors) and quantitative (self-reported measures, non–self-reported measures) assessment and regards the qualitative pain narrative as the best available root proxy for inferring pain in others. MAP offers frameworks to better address pain subjectivity by: (1) delineating separate criteria for identifying versus assessing pain. Pain is identified through narrative reports, while comprehensive assessment is used to infer why pain is reported; (2) integrating compassion-based and mechanism-based management by both validating pain reports and assessing underlying processes; (3) conceptualizing comprehensive pain assessment as both multidimensional and multimodal (listening/observing and measuring); and (4) describing how qualitative data help validate and contextualize quantitative pain measures. Discussion: MAP is expected to help clinicians validate pain reports as important and legitimate, regardless of other findings, and help our field develop more comprehensive, valid, and compassionate approaches to assessing pain.

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

Cited by 51 publications

References 211 publications

Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

The lived experience of working with people with eating disorders: A meta‐ethnography

The Multimodal Assessment Model of Pain

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