Exploring the development of interprofessional competence and professional identity: A Situated Learning Theory study.

Workplace-based learning provides medical students exposure to interprofessional competencies through repeated exposures and active participation in interprofessional learning activities. Using Situated Learning Theory as our theoretical lens, we explored with medical students how interacting with existing interprofessional teams contributes to development of an expanded health care professional identity. An embedded mixed methods study using semi-structured interviews and questionnaires to assess readiness for interprofessional learning was conducted with 14 medical students completing an elective at an interprofessional pain medicine clinic. Within this workplace-based context, a model identifying key themes and supporting factors contributing to the development of an extended professional identity was developed. These findings help describe the processes by which students gain interprofessional collaboration competence.

Nursing students' experiences and perceptions of an innovative graduate level healthcare grand challenge course: a qualitative study.

Nursing leaders are increasingly required to create and implement innovative solutions to address challenges in the workplace. However, the present-day education of graduate nurses may not adequately prepare them for entrepreneurial approaches to problem solving required in today's complex healthcare environments. To fill this gap, we designed, implemented, and evaluated a Healthcare Grand Challenge course for graduate nurses interested in developing their leadership skills. Following the course, students were invited to participate in a qualitative research study to explore their experiences and perceptions of the course and identify how they used the knowledge and skills developed through the course in their leadership practices. This study provides key lessons for future offerings of grand challenge courses while highlighting the influence of grand challenge courses on current and future nursing leadership practice.

Older women's experiences of companion animal death: impacts on well-being and aging-in-place.

BACKGROUND: Companion animal death is a common source of grief, although the extent and context of that grief is poorly understood, especially in older adulthood. The aim of this multiple-methods study was to develop a greater understanding of the impact of companion animal death on older women living alone in the community, as older women are a distinct at-risk group, and the supports that should be available to help these individuals with their grief. METHODS: Participants were recruited from across Alberta, a Canadian province, through seniors' organizations, pet rescue groups, and social media groups of interest to older women. After completing a pre-interview online questionnaire to gain demographic information and standardized pet attachment and grief measures data, participants were interviewed through the Zoom ® computer program or over the telephone. An interpretive description methodology framed the interviews, with Braun and Clarke's 6-phase analytic method used for thematic analysis of interview data. RESULTS: In 2020, twelve participants completed the pre-interview questionnaires and nine went on to provide interview data for analysis. All were older adult (age 55+) women, living alone in the community, who had experienced the death of a companion animal in 2019. On the standardized measures, participants scored highly on attachment and loss, but low on guilt and anger. The interview data revealed three themes: catastrophic grief and multiple major losses over the death of their companion animal, immediate steps taken for recovery, and longer-term grief and loss recovery. CONCLUSIONS: The findings highlight the importance of acknowledging and addressing companion animal grief to ensure the ongoing well-being and thus the sustained successful aging-in-place of older adult women in the community.

Does breastfeeding self-efficacy theory apply to mothers of moderate and late preterm infants? A qualitative exploration.

BACKGROUND: Breastmilk feeding reduces morbidities and improves outcomes related to prematurity. However, breastmilk feeding rates in preterm infants are substantially lower than those in term infants. Breastfeeding self-efficacy theory is a social change theory, which is predictive of exclusive breastmilk feeding at 2 months postpartum in mothers of full-term infants. However, this theory has not been well explored in mothers of moderate and late preterm infants. AIMS AND OBJECTIVES: To explore maternal experiences with feeding moderate (320/7 - 336/7  weeks' gestational age) and late preterm infants (340/7 - 366/7  weeks' GA) in neonatal intensive care units and assess applicability of breastfeeding self-efficacy theory. METHODS: We conducted a qualitative descriptive exploration of maternal experiences with infant feeding in neonatal intensive care units. Using purposive, maximum variation sampling, we selected mothers of preterm infants born at 320/7 - 346/7  weeks, who experienced high mean differences in their BSE scores between admission and discharge. Fourteen mothers participated in semi-structured telephone interviews. Data were examined using thematic analysis. To explore and describe breastfeeding self-efficacy within the context of neonatal intensive care units, we super-imposed the four sources of information from breastfeeding self-efficacy theory onto the defined themes. RESULTS: Three main themes emerged: (a) institutional influences, (b) relationship with the pump and (c) establishing breastfeeding, with an emphasis on the importance of direct breastfeeding at discharge. Overlaying the four sources of information from breastfeeding self-efficacy highlighted the presence of three sources of information: verbal persuasion, performance accomplishment and physiologic/affective responses. Vicarious experience was not identified in maternal experiences with infant feeding. CONCLUSION: Our findings indicate that breastfeeding self-efficacy is an applicable theory for mothers of preterm infants. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers need to be aware of the influence that institutional culture and policies may have on maternal breastfeeding self-efficacy and breastfeeding outcomes.

Co-design of a patient experience survey for arthritis central intake: an example of meaningful patient engagement in healthcare design.

BACKGROUND: To describe the process of patient engagement to co-design a patient experience survey for people with arthritis referred to central intake. METHODS: We used a participatory design to engage with patients to co-design a patient experience survey that comprised three connected phases: 1) Identifying the needs of patients with arthritis, 2) Developing a set of key performance indicators, and 3) Determining the survey items for the patient experience survey. RESULTS: Patient recommendations for high quality healthcare care means support to manage arthritis, to live a meaningful life by providing the right knowledge, professional support, and professional relationship. The concept of integrated care was a core requirement from the patients' perspective for the delivery of high quality arthritis care. Patients experience with care was ranked in the top 10 of 28 Key Performance Indicators for the evaluation of central intake, with 95% of stakeholders rating it as 9/10 for importance. A stakeholder team, including Patient and Community Engagement Researchers (PaCER), mapped and rated 41 survey items from four validated surveys. The final patient experience survey had 23 items. CONCLUSION: The process of patient engagement to co-design a patient experience survey, for people with arthritis, identified aspects of care that had not been previously recognized. The linear organization of frameworks used to report patient engagement in research does not always capture the complexity of reality. Additional resources of cost, time and expertise for patient engagement in co-design activity are recognized and should be included, where possible, to ensure high quality data is captured.

The quest of pain education leaders in Canada and the United States: a qualitative study.

AIMS: To determine key factors that stimulate and drive the ongoing interests of leaders in the field of pain to continue to work for change and to explore how they use their own experiences in their teaching. BACKGROUND: The assessment and management of acute and chronic pain remains a challenge and the pain education of pre-licensure/undergraduate health professionals (e.g. nurses, physicians, etc.) continues to be suboptimal. Understanding the motivations of pain leaders may provide insights to facilitate the future development of pain clinicians. DESIGN: A Narrative enquiry. METHODS: A purposeful sample of 17 Canadian and USA leaders in pain education participated. Data were collected between September 2012-January 2013 using recorded semi-structured telephone interviews. Transcripts were coded to provide storied experiences (themes). FINDINGS: Six themes were identified as a stimulus for pain leaders: An early pain experience, mentorship and circumstances, a personal shift in understanding, catalysts (institutional or political), recognition of barriers and a determination to improve. Their work towards change appeared to be motivated by their pain 'quest' where leaders embraced their personal experiences of pain, a need for social action and individual change. CONCLUSIONS: Educational approaches for health professionals usually focus on the importance of knowledge, skills and attitudes to be competent in pain care. To inspire and educate young health professionals about pain management we suggest the development of future pain leaders may require a different approach that recognizes personal stories of pain, includes a local pain champion and incorporates a model of mentorship.

Physical Functioning and Opioid use in Patients with Neuropathic Pain.

OBJECTIVE: To evaluate the association between opioid dosage and ongoing therapy with physical function and disability in patients with neuropathic pain (NeP). DESIGN: Secondary analysis of a prospective cohort. SETTING: Multicenter clinical NeP registry. SUBJECTS: Seven hundred eighty-nine patients treated for various NeP diagnoses. METHODS: The following measures were included: dependent variables. 12-month self-reported physical function (pain disability index [PDI] and medical outcomes study short form-12 physical function [PCSS-12]); independent variables: baseline opioid dose (none, ≤200 mg and >200 mg of morphine equivalent), ongoing opioid use; potential confounding variables: age, sex, baseline pain intensity, and psychological distress (profile of mood states). Analysis of covariance models was created to examine the relationship between opioid therapy and both physical functioning outcomes with adjustment for confounding. RESULTS: Complete data was available for 535 patients (68%). Compared with the lower and high dose opioid groups, NeP patients not taking opioids had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Compared with patients prescribed opioid therapy on an ongoing basis, NeP patients who were not prescribed had statistically lower disability and higher physical functioning scores, after adjusting for disease severity. Improvements in disability and physical functioning scores from baseline and 12-months in all groups were modest and may not be clinically significant. CONCLUSIONS: Physical functioning and disability did not improve in patients with NeP who were prescribed opioids compared with those who are not prescribed, even after adjusting for disease severity.

Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies.

Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. Our team was funded to complete a meta-ethnography of patients' experience of chronic musculoskeletal pain. It has been 25 years since Noblit and Hare published their core text on meta-ethnography, and the current health research environment brings additional challenges to researchers aiming to synthesise qualitative research. Noblit and Hare propose seven stages of meta-ethnography which take the researcher from formulating a research idea to expressing the findings. These stages are not discrete but form part of an iterative research process. We aimed to build on the methods of Noblit and Hare and explore the challenges of including a large number of qualitative studies into a qualitative systematic review. These challenges hinge upon epistemological and practical issues to be considered alongside expectations about what determines high quality research. This paper describes our method and explores these challenges. Central to our method was the process of collaborative interpretation of concepts and the decision to exclude original material where we could not decipher a concept. We use excerpts from our research team's reflexive statements to illustrate the development of our methods.

Pain: a quality of care issue during patients' admission to hospital.

AIM: To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge. BACKGROUND: The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals. DESIGN: A descriptive cross-sectional exploratory design. METHOD: A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge. FINDINGS: A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs. CONCLUSION: Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience.

An Integrative Review of the Literature on Pain Management Barriers: Implications for the Canadian Clinical Context.

Despite decades of pain research, substandard pain management continues to be distressingly prevalent across health-care settings. This integrative literature review analyzes and synthesizes barriers to effective pain management and identifies areas for future investigation in a Canadian context. Three sets of key barriers were identified through thematic analysis of 24 original research studies published in the period 2003-13: patient, professional, and organizational. These barriers rarely occurred in isolation, with many studies reporting examples in all three categories. This suggests that interventions need to reflect the multifactorial nature of pain management. Reframing pain education as a public health initiative could lead to sustainable improvement, as could the strengthening of partnerships between patients and health-care providers. There are tremendous opportunities for the advanced practice nurse to take a lead in pain management. The delivery of high-quality care that encompasses effective pain management strategies must be a priority for nursing. Research approaches, such as pragmatic mixed methods, that offer contextual understanding of how pain is managed are suggested.

Bien que la question de la douleur ait fait l'objet de recherches depuis plusieurs décennies, la douleur est encore très mal gérée dans la plupart des milieux de la santé. Le présent examen par intégration de la littérature analyse et fait la synthèse des obstacles qui empêchent une gestion efficace de la douleur et identifie des domaines qui devront faire l'objet d'études en contexte canadien. Trois types d'obstacles ont été identifiés à l'aide d'une analyse thématique de 24 études originales publiées entre 2003 et 2013: ceux qui relèvent du patient, ceux d'ordre professionnel et ceux de nature organisationnelle. Ces obstacles se manifestent rarement de façon isolée et nombre d'études offrent des exemples des trois types, ce qui suggère que les interventions doivent refléter la nature multifactorielle de la gestion de la douleur. Le recadrage de l'éducation en matière de douleur dans le cadre d'une initiative de santé publique pourrait mener à des améliorations durables, tout comme le renforcement des partenariats entre les patients et les professionnels de la santé. Les occasions qui s'offrent aux infirmières en pratique avancée de jouer un rôle de premier plan en matière de gestion de la douleur sont immenses. La prestation de soins de grande qualité qui s'appuient sur des stratégies de gestion de la douleur efficaces doit être une priorité en soins infirmiers. Les auteures suggèrent l'adoption d'approches de recherche offrant une compréhension contextuelle de la gestion de la douleur, telles les méthodes mixtes pragmatiques.

'Trying to pin down jelly' - exploring intuitive processes in quality assessment for meta-ethnography.

BACKGROUND: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the 'quality' of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. METHODS: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. RESULTS: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation 'be trusted?' Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? CONCLUSIONS: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged 'good enough' there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies.

Met or matched expectations: what accounts for a successful back pain consultation in primary care?

BACKGROUND: Patients' as well as doctors' expectations might be key elements for improving the quality of health care; however, previous conceptual and theoretical frameworks related to expectations often overlook such complex and complementary relationship between patients' and doctors' expectations. The concept of 'matched patient-doctor expectations' is not properly investigated, and there is lack of literature exploring such aspect of the consultation. AIM: The paper presents a preliminary conceptual model for the relationship between patients' and doctors' expectations with specific reference to back pain management in primary care. METHODS: The methods employed in this study are integrative literature review, examination of previous theoretical frameworks, identification of conceptual issues in existing literature, and synthesis and development of a preliminary pragmatic conceptual framework. OUTCOME: A simple preliminary model explaining the formation of expectations in relation to specific antecedents and consequences was developed; the model incorporates several stages and filters (influencing factors, underlying reactions, judgement, formed reactions, outcome and significance) to explain the development and anticipated influence of expectations on the consultation outcome. CONCLUSION: The newly developed model takes into account several important dynamics that might be key elements for more successful back pain consultation in primary care, mainly the importance of matching patients' and doctors' expectations as well as the importance of addressing unmet expectations.

Back pain management in primary care: development and validity of the Patients' and Doctors' Expectations Questionnaire.

BACKGROUND: Back pain is a common disorder, with the doctor being the first point of contact for help. Biopsychosocial management of back pain has been shown to be problematic. Meeting patients' expectations is alleged to play a vital role in concordance, adherence and satisfaction. A more potent aspect, however, could be a state of matched patient- doctor expectations with regard to the consultation process and outcome, but this aspect has not been fully investigated and there is currently no valid and specific measure of this dimension. AIM: To report on the development of a newly designed patient and doctor expectations questionnaire that measures the matching of their expectations with regard to the back pain consultation in primary care, and to establish the validity and internal consistency of the new tool. METHODS: A literature review was carried out and a draft 36-item questionnaire was developed. Thirty-eight subjects (7 researchers, 20 patients and 11 doctors) tested the questionnaire. Each subject gave feedback on the questionnaire design and was also asked to fill in a previously validated tool, the Patients' Intentions Questionnaire (PIQ), to establish the concurrent validity of the newly designed expectations questionnaire. Construct validity was established by calculating the Spearman correlation coefficient, and Cronbach's alpha was computed to reflect the internal consistency of the instrument. FINDINGS: The results of the validity questionnaire showed that the questionnaire was perceived as simple, clear and easy to understand and appropriate to the intended aim. Spearman correlation coefficients between the Patients' Expectations Questionnaire and PIQ showed significant correlation ( r = 0.65), reflecting good concurrent validity, while Cronbach's alpha was 0.831, reflecting good internal consistency. CONCLUSION: The newly designed questionnaire showed good face, content and construct validity as well as good internal consistency, and thus can be used as a valid and reliable measure for back pain-specific expectations of the process and outcome of the consultation in primary care settings.

Improving services for back pain: putting the patient at the centre of interprofessional education.

INTRODUCTION: Studies exploring the role of patients in interprofessional education (IPE) are found primarily in undergraduate programmes with few reporting on the postgraduate (continuing professional development) setting. This paper describes an interprofessional quality improvement project around the management of back pain in a primary care setting where patients were part of the practice team. METHODS: Patients participated in eight half-day IPE workshops delivered to nine general practice teams in the UK. Educational content included knowledge about quality improvement and evidence-based back pain knowledge, with teamwork, experiential and didactic learning approaches. On-site practice support from a quality improvement facilitator occurred between the workshops to strengthen practice-based learning. Forty-four practice staff and 11 patients attended the workshops and the facilitated project meetings. Evaluation occurred through focus groups with practice teams (including patients) both before and after the workshops. These were recorded, transcribed and analysed by coding and the inductive development of themes. RESULTS: The context of managing back pain was particularly challenging. Focus group participants indicated that patient involvement was highly valued as it gave practitioners a greater understanding of the effects of back pain on their lives whilst permitting patients to hear the experiences of others and to understand their own world better. Listening was important to patients' experiences of healthcare and practitioners' experiences of the workshops. Learning together emerged as particularly important and finally the challenge of finding time to learn together infiltrated the entire endeavour and was a prominent concern. DISCUSSION: Patients sharing their experience of back pain appeared to be a particularly pivotal point in the learning for practice teams. Meaningful engagement with users in IPE was highly valued and provided a catalyst for behavioural change, where professionals relinquished an unhelpful medical model in favour of an integrative biopsychosocial one.

Canine Caregivers: Paradoxical Challenges and Rewards.

Companion dogs are increasingly popular, 38.4% of households in the United States include at least one dog. There are numerous benefits to sharing one's home with a dog, but because they age more rapidly than people and have shorter lifespans, acquiring a dog often includes caring for it during its senior years. Caring for an elderly dog can be physically and emotionally challenging, yet the impact on guardians' lives when caring for an aging dog has received minimal scientific attention. This study was designed to better understand dog guardians' experiences and perceptions related to caring for their aging dog. Utilizing an exploratory mixed methods design, this study asked dog guardians to complete an online anonymous survey. From a total of 284 participants, we found that the impact on guardians when caring for an aging dog appears to share many similarities with caregivers of human family members. Our quantitative and qualitative results suggest that, for many guardians, caring for an aging dog is a complex dynamic with both positive and negative factors that offers an opportunity to deepen the human-animal bond and create positive, rewarding experiences and memories.

Outcomes of a controlled trial with visiting therapy dog teams on pain in adults in an emergency department.

CONTEXT: Pain is a primary reason individuals attend an Emergency Department (ED), and its management is a concern. OBJECTIVES: Change in symptoms and physiologic variables at 3 time points pre-post a ten-minute St. John Ambulance therapy dog team visit compared to no visit in ED patients who experienced pain. DESIGN, SETTING AND PARTICIPANTS: Using a controlled clinical trial design, pain, anxiety, depression and well-being were measured with the Edmonton Symptom Assessment System (revised version) (ESAS-r) 11-point rating scales before, immediately after, and 20 minutes post- therapy dog team visit with Royal University Hospital ED patients participating in the study (n = 97). Blood pressure and heart rate were recorded at the time points. Control data was gathered twice (30 minutes apart) for comparison (n = 101). There were no group differences in age, gender or ethnicity among the control and intervention groups (respectively mean age 59.5/57.2, ethnicity 77.2% Caucasian/87.6%, female 43.6% /39.2%, male 56.4%/60.8%,). INTERVENTION: 10 minute therapy dog team visit in addition to usual care. MAIN OUTCOME MEASURES: Change in reported pain from pre and post therapy dog team visit and comparison with a control group. RESULTS: A two-way ANOVA was conducted to compare group effects. Significant pre- post-intervention differences were noted in pain for the intervention (mean changeint. = -0.9, SD = 2.05, p = .004, 95% confidence interval [CI] = [0.42, 1.32], ηp2 = 04) but not the control group. Anxiety (mean changeint. = -1.13, SD = 2.80, p = .005, 95% CI = [0.56, 1.64], ηp2 = .04), depression (mean changeint. = -0.72, SD = 1.71, p = .002, 95% CI = [0.39, 1.11], ηp2 = .047), and well-being ratings (mean changeint. = -0.87, SD = 1.84, p < .001, 95% CI = [0.49, 1.25], ηp2 = .07) similarly improved for the intervention group only. There were no pre-post intervention differences in blood pressure or heart rate for either group. Strong responders to the intervention (i.e. >50% reduction) were observed for pain (43%), anxiety (48%), depression (46%), and well-being (41%). CONCLUSIONS: Clinically significant changes in pain as well as significant changes in anxiety, depression and well-being were observed in the therapy dog intervention compared to control. The findings of this novel study contribute important knowledge towards the potential value of ED therapy dogs to affect patients' experience of pain, and related measures of anxiety, depression and well-being. TRIAL REGISTRATION: This controlled clinical trial is registered with ClinicalTrials.gov, registration number NCT04727749.

Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study.

BACKGROUND: Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes. METHODS: We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation. RESULTS: Data for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups. CONCLUSIONS: GP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were small and limited and the reasons for them remain obscure. However, such is the impact of back pain and its frequency of consultation in general practice that this kind of improvement methodology deserves further consideration. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN30420389.

Making sense of patients' use of analgesics following day case surgery.

AIM: This paper is a report of a study exploring patients' use of analgesics following day case surgery, with particular focus on patients' decision-making about analgesic use. BACKGROUND: Day case and ambulatory surgery continue to be the preferred format for many elective surgical procedures. However, many patients' experience unacceptable postoperative pain when they return home after day surgery. Previous research investigating barriers to pain management suggests that patients may not use their analgesics appropriately. METHOD: A qualitative approach using interpretative phenomenological analysis was used to explore the experiences of 28 patients admitted for day case surgery. The patients were interviewed on the fourth postoperative day. Data were collected in 2005-06. FINDINGS: We identified an explanatory framework with three high level themes and 12 mid-level themes, with the mid-level themes broken down into a number of lower level themes. Patients' use of analgesics was a complex intentional decision-making process based on a matrix of beliefs surrounding pain, analgesics and day surgery. They did not always adhere to their analgesic regimes at home, many describing how they avoided analgesics and often withstood high levels of postoperative pain. CONCLUSION: Interventions need to go beyond the provision of pain management information (as in current practice), and overcome some of the erroneous beliefs held by patients. Further research is required to identify ways in which these erroneous beliefs can be overcome.

Motivations and expectations for using cannabis products to treat pain in humans and dogs: a mixed methods study.

BACKGROUND: Social media and academic literature suggest that more people are using cannabis to treat their own or their dog's chronic pain. This study identifies the reasons people use cannabis products to treat their own pain or their dog's pain and explores whether these products have fulfilled their expectations. METHODS: An anonymous, online survey was used to collect quantitative and qualitative self-report data on respondents' perceptions, motivations and expectations about their or their dog's chronic pain and cannabis use. The analyses are based on U.S. adults who reported using cannabis products to treat their own (N = 313) or their dog's (N = 204) chronic pain. Quantitative responses from the two groups were compared using Chi-Square tests and qualitative data were analyzed using a thematic analysis. RESULTS: Human patients and dog owners reported similar motivations for using cannabis products to treat chronic pain, with the more popular reasons being that cannabis products are natural, are preferred over conventional medication, are believed to be the best treatment or good treatment option for pain. Similar proportions of human patients and dog owners reported that the use of cannabis products fulfilled their expectations (86% vs. 82% respectively, χ2 (1, 200) = .59, p = .32). The qualitative data revealed that their expectations were met by reducing pain, increasing relaxation, and improving sleep, coping, functionality and overall well being. Additionally, the qualitative data suggests that cannabis products offer a return to normalcy and a restored sense of self to human and dog patients. CONCLUSIONS: The results suggest that people choose cannabis products because they are natural and a possible solution to managing chronic pain when conventional medicines have not been effective. Most people report that their expectations regarding pain management are fulfilled by these products. More accurate assessments are vital, however, for understanding both the objective biomedical and subjective socioemotional benefits of cannabis products for effective pain management for human and dog patients. In addition, objective factual information regarding cannabis products for effective pain management in humans and dogs is needed. It is recommended that both physicians and veterinarians work towards feeling more comfortable proactively broaching the subject of cannabis use with additional training and education.