TY - JOUR
T1 - Patients and clinicians have different priorities when discussing pain in the IBD clinic
AU - Huisman, Danielle
AU - Andrews, Esther
AU - Williams, Amanda C.De C.
AU - Parkes, Miles
AU - Norton, Christine
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/10/29
Y1 - 2024/10/29
N2 - Objective Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain. Methods In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups. Results Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain). Conclusion The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.
AB - Objective Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians' conceptualisations of patients' pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain. Methods In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups. Results Clinicians state that they regularly ask about pain in Crohn's disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain). Conclusion The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.
KW - ABDOMINAL PAIN
KW - CROHN'S DISEASE
KW - IBD CLINICAL
KW - INFLAMMATORY BOWEL DISEASE
KW - ULCERATIVE COLITIS
UR - http://www.scopus.com/inward/record.url?scp=85213895199&partnerID=8YFLogxK
U2 - 10.1136/bmjgast-2024-001540
DO - 10.1136/bmjgast-2024-001540
M3 - Article
AN - SCOPUS:85213895199
SN - 2054-4774
VL - 11
JO - BMJ open gastroenterology
JF - BMJ open gastroenterology
IS - 1
M1 - e001540
ER -