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UNDERSTANDING HOW PRIMARY CARE CLINICIANS MAKE SENSE OF CHRONIC PAIN. Cogn Technol Work 2018 Nov;20(4):575-584

Date

03/08/2019

Pubmed ID

30842708

Pubmed Central ID

PMC6398613

DOI

10.1007/s10111-018-0491-1

Scopus ID

2-s2.0-85047782892 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the U.S. and some other countries, the complexities of caring for chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. To help understand and improve pain care, this article uses the data-frame theory of sensemaking to explore how primary care clinicians in the U.S. manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with 10 primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patient, social/environmental, and clinician factors that influence the frames clinicians use to assess their patients and determine a pain management plan. Findings suggest significant ambiguity and uncertainty in clinical pain management decision making. Therefore, interventions to improve pain care might focus on supporting sensemaking in the context of clinical evidence rather than attempting to provide clinicians with decontextualized and/or algorithm-based decision rules. Interventions might focus on delivering convenient and easily interpreted patient and social/environmental information in the context of clinical practice guidelines.

Author List

Militello LG, Anders S, Downs SM, Diiulio J, Danielson EC, Hurley RW, Harle CA

Author

Robert W. Hurley MD, PhD Adjunct Professor of Anesthesiology and CTSI in the Anesthesiology department at Medical College of Wisconsin