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Understanding how primary care clinicians make sense of chronic pain

Abstract

Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the US 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 US manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with ten primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patients, 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.

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Acknowledgements

We would like to thank Robert Cook and Burke Mamlin for help in interpreting the findings for this study. This project was supported by grant number R01HS023306 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

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Correspondence to Laura G. Militello.

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Militello, L.G., Anders, S., Downs, S.M. et al. Understanding how primary care clinicians make sense of chronic pain. Cogn Tech Work 20, 575–584 (2018). https://doi.org/10.1007/s10111-018-0491-1

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Keywords

  • Sensemaking
  • Health
  • Primary care
  • Chronic pain
  • Decision making
  • Opioids