A recent systematic review1 of population studies indicates that as many as 28 million adults in the UK are affected by chronic pain. Population estimates suggest that around 25% of adults around the world suffer with moderate or severe pain,2–6 and for between 6% and 14% of these adults this pain is disabling.6,7 We know that living with chronic pain can be challenging and that patients do not always feel valued or believed by health-care professionals (HCPs).8 To improve these patients’ experiences of health care, we need to understand what is going on from the perspective of the HCP. In particular, we need to understand why it is that working with people with chronic non-malignant pain can result in patients experiencing this as an adversarial relationship. If we can understand what it is like to be a HCP providing health care to people with chronic non-malignant pain, and in particular its challenges and rewards, this understanding can facilitate improvements in the experience and quality of health care for this large group of people.
Chronic pain can be particularly challenging for HCPs to treat because it persists beyond the expected healing time and is not amenable to routine methods of pain control.9 This is complicated by the finding that pain is not always explained by a specific pathology.6 HCPs find working with patients with chronic pain very complex. For example, HCPs describe feeling ‘bombarded by despair’ under the pressure of not being able to fix the person in pain.10 They can also find it a challenge to balance empathy with ‘not getting too involved’.10 Allegretti and colleagues11 describe the challenges for general practitioners (GPs) and highlight mismatches in patients’ and clinicians experiences of health care. Others report feelings of frustration and discord in the patient–clinician relationship.12 It is not uncommon for patients to report dissatisfaction with their HCP interaction and this is likely to influence their decisions and actions.13 The rationale for this study is underpinned by the need to facilitate ‘patient-centred medicine’.14 Mead and Bower15 identified five key dimensions of patient-centred medicine: (1) taking a biopsychosocial perspective; (2) framing the ‘patient-as-person’; (3) sharing power and responsibility; (4) therapeutic alliance, which hinges on an effective personal relationship; and (5) ‘doctor-as-person’, which recognises the influence that HCPs’ personal characteristics and responses can have on care. Mead and Bower15 indicate that patient-centred care requires HCPs to be self-aware of their emotional responses and reactions: ‘sensitivity and insight into the reactions of both parties can be used for therapeutic purposes’. Thus, understanding the experience of providing health care to people with chronic non-malignant pain from the perspective of the HCP can have important implications for delivery of health care, decision-making and health-care quality. The findings will allow HCPs and their managers to understand, in detail, the challenges of providing health care to this complex group of patients and, thus, facilitate improvements to the quality of health care. In addition, a mutual understanding of what it is like to provide and receive health care for chronic non-malignant pain can facilitate a therapeutic partnership from the perspective of both patients and their HCPs.
The aim of qualitative evidence synthesis (QES) in health care is to systematically review and integrate findings in order to increase our understanding of the complex processes of health care and, thus, improve the experience and quality of that care. The proliferation of qualitative studies can make it difficult to access and utilise qualitative knowledge to inform practice and policy.16 The Cochrane Qualitative Research Methods Group acknowledges the importance of including qualitative findings within evidence-based health care,17 and insights from several meta-ethnographies have contributed to a greater understanding of complex processes in health care, for example medicine-taking,18 diabetes,19 antidepressants,20 chronic musculoskeletal pain8 and chronic pelvic pain.21 There are various methods for synthesising qualitative research.16,22–25 An important distinction made in synthesis approaches is between (1) those that aim to describe or ‘aggregate’ findings and (2) those that aim to interpret these findings and develop conceptual understandings or ‘theory’.26 Our aim is to develop conceptual understanding. We will use the methods of meta-ethnography developed, refined and reported by Toye and colleagues8 in a previous meta-ethnography of patients’ experience of chronic musculoskeletal pain.
Objectives
- To undertake a QES (meta-ethnography)26–28 that will increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain and, thus, to inform improvements in the experience and quality of health care.
- To make our findings easily available and accessible through a short film.
- To contribute to the development of methods for QES that aim to bring together qualitative research findings so that health care can be improved.