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BACKGROUND/RATIONALE:
Pain management is a persistent and pervasive problem in healthcare and has been identified as an area of high priority by the VHA. Existing research has clearly documented ongoing problems with both quality and equity in pain management across a variety of treatment settings and disease types. Yet the processes by which pain routinely goes undertreated remain poorly understood. Although researchers agree that clinical decision-making in pain management is strongly influenced by nonclinical factors such as provider knowledge, attitudes, beliefs and values regarding pain and its treatment, little empirical data are available on these sociocultural dimensions of pain management.
OBJECTIVE(S):
This project aims to advance understanding of the factors critical to improving the quality and equity of pain management for veterans by studying the sociocultural factors involved in provider decision-making about pain management. With this in mind, our specific objectives are: 1) to describe key patient, provider and practice-setting factors that influence provider decision-making about the assessment, diagnosis and treatment of nonmalignant pain; 2) to assess the relationships between and relative importance of identified patient, provider and practice-setting factors in shaping provider decision-making in nonmalignant pain management; and 3) to identify key patient, provider and/or practice-setting factors (or sets of factors) as priorities for intervention-targeted work to improve the quality and equity of pain management.
METHODS:
This is a prospective ethnographic study of provider decision-making in pain management. The study approach combines qualitative and quantitative methods, including 1) shadow observation of provider interactions with patients and with other members of the clinical team, 2) in-depth interviewing with providers, and 3) quantitative coding of key provider-patient encounter data. A sample of 60-75 healthcare providers will be drawn from VA primary care, emergency care, and surgery services in two urban VA hospitals for intensive ethnographic study of clinical decision-making about pain management as it occurs in real-world settings.
FINDINGS/RESULTS:
Preliminary data analysis has been initiated and suggests that important practice-setting (e.g. primary vs. emergency care) and institutional differences do exist in pain management attitudes and practices. Preliminary analysis has also begun to examine the role of provider "index" pain experiences as well as clinical team interactions in shaping approaches to managing pain.
IMPACT:
Given the ubiquity of suboptimal pain management across treatment settings and disease types, the potential impact of research designed to better understand - and thus improve - problems of quality and equity in pain management is particularly high. The proposed ethnographic research aims to produce valuable data on the sociocultural factors that influence provider decision-making about pain management not available through standard quantitative approaches. Findings from this research will inform both future interventions and the development of policy to improve the overall quality and equity of pain management within the VA Healthcare System and beyond.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Special (Underserved, High Risk) Populations
DRE:
Communication and Decision Making, Treatment
Keywords:
Behavior (provider), Ethnic/cultural, Pain
MeSH Terms:
none
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