Patients' peri-operative experiences with non-pharmacologic pain care techniques: a secondary qualitative analysis of the NOHARM trial.

Abstract

Background: Peri-operative pain management guidelines recommend multimodal strategies, but education on non-pharmacological pain care (NPPC) is lacking. The present study explored patients' experiences participating in the Healing After Surgery (HAS) initiative as part of a pragmatic clinical trial, designed to provide patients with peri-operative education and support for using NPPC.

Methods: We sought to interview two patients from each of the 31 surgical practices participating in the trial. Interviews were semi-structured, audio-recorded, and transcribed verbatim. We used a rapid analytic approach to summarize interview transcripts. Summaries were uploaded to NVivo and two researchers independently reviewed queries and produced analytic memos with key themes organized according to the Theoretical Framework of Acceptability's seven constructs.

Results: We analyzed interview transcripts for 71 patients. Findings revealed that patients (1) generally liked the HAS initiative (affective attitude), (2) it aligned with patients' beliefs about wellness techniques and concerns about opioids (ethicality), and (3) many patients had experience using NPPC (self-efficacy). However, (4) care team education and provision of NPPC was inconsistent (intervention coherence), (5) patients varied on their thoughts about the effectiveness of NPPC and the role of NPPC and medication (perceived effectiveness), (6) some patients found resources repetitive and encountered logistical challenges engaging with resources or using NPPC (burden), and (7) patients cited completing tasks ahead of surgery and competing demands post-operatively (e.g., caring for a spouse or young children) as barriers (opportunity costs). An additional theme, the invisible and individualistic nature of pain, also emerged.

Conclusions: Peri-operative initiatives that educate patients about NPPC may be well-received and remind patients of "wellness techniques" and alert them to their role in pain management. Familiarity with NPPC may contribute to patients' self-efficacy using these techniques. However, some patients may require additional support to feel comfortable using NPPC in a post-operative context. Emphasizing the care team's role of directing patients to existing educational recourse or interactive supportive resources may be a low burden way of providing this support. Adding a health coach role to the intervention may also be an option for providing extra support without increasing care teams' workload.

Trial registration: This study was registered on ClinicalTrials.gov, NCT05166356, https://clinicaltrials.gov/study/NCT05166356?term=%20NCT05166356&rank=1 Patient enrollment began on 3/01/2022.