"IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain

Bernadette Brady; Sheng Min Pang; Sarah Dennis; Lucy Chipchase; Pranee Liamputtong; Matthew Jennings; Elise Tcharkhedian; Toni Andary; Natalie Pavlovic; Marguerite Zind; Paul Middleton; Robert Boland

doi:10.1002/msc.1874

"IT's too much to do alone": A mixed-methods exploration of patient experiences implementing emergency department management plans for chronic pain

Musculoskeletal Care. 2024 Mar;22(1):e1874. doi: 10.1002/msc.1874.

Authors

Bernadette Brady^{1

2

3}, Sheng Min Pang³, Sarah Dennis^{3

4}, Lucy Chipchase^{1

5}, Pranee Liamputtong^{6

7}, Matthew Jennings^{1

2}, Elise Tcharkhedian^{1

2}, Toni Andary^{8

9}, Natalie Pavlovic⁸, Marguerite Zind¹, Paul Middleton^{2

10

11

12

13}, Robert Boland^{3

8}

Affiliations

¹ School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.
² Liverpool Hospital, Liverpool, New South Wales, Australia.
³ Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
⁴ Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
⁵ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
⁶ College of Health Sciences, VinUniversity, Hanoi, Vietnam.
⁷ Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia.
⁸ Physiotherapy Department, Fairfield Hospital, Fairfield, New South Wales, Australia.
⁹ School of Medical Sciences, UNSW Medical School, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ South Western Emergency Research Institute (SWERI), The Ingham Institute, Liverpool, New South Wales, Australia.
¹¹ South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
¹² Discipline of Emergency Medicine, University of Sydney, Sydney, New South Wales, Australia.
¹³ The MARCS Institute for Brain, Behaviour & Development, Western Sydney University, Sydney, New South Wales, Australia.

PMID: 38423991
DOI: 10.1002/msc.1874

Abstract

Objectives: To explore the experiences of socio-culturally diverse community members attempting to manage their chronic pain and enact evidence-based management plans following an index Emergency Department (ED) visit.

Methods: A convergent parallel mixed-methods design with qualitative interviews and descriptive analysis was undertaken in two public hospitals in a multicultural region in Sydney, Australia. Consecutive adults were recruited from culturally and linguistically diverse (CALD: n = 45) or Australian-born (n = 45) backgrounds, who presented to the ED for a chronic neuromusculoskeletal pain condition. Consenting participants were prescribed an individualised chronic pain management plan following examination by a physiotherapist, who collected standardised measures of pain and health literacy. Six months later, participants underwent a structured phone survey regarding their pain status and whether they had actioned management plans. Participants were invited to participate in a semi-structured interview.

Results: Six-month data were available for 82 of 90 participants who attended the ED and consented to the baseline assessment (40 CALD and 42 Australian-born). Participants were 52% females, predominately middle-aged (mean age 54.7 years), with an overall mean symptom duration of 10 years (SD 9.0). At 6 months, there were nine representations by six CALD participants and 23 by nine Australian-born participants. Overall, 52% reported unchanged pain, 24% were worse and 23% improved, with similar action plan progress for CALD (58%) and Australian-born (53%) participants. Pain features and health literacy were similar, irrespective of progress with pain management plans. From 41 participants who consented to phone interviews, three themes emerged to explain their progress with recommendations: 'illness model', 'urgency' and 'control orientation'.

Conclusions: Patients presenting to the ED with chronic pain might be more likely to action discharge recommendations if primary care providers identify patient-specific and contextual barriers to implementation.

Keywords: chronic pain; culturally and linguistically diverse; emergency department; self-management.

MeSH terms

Adult
Australia
Chronic Pain* / therapy
Cultural Diversity
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Patient Outcome Assessment

Abstract

MeSH terms

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