Danielle Huisman, Esther Andrews, Amanda C de C Williams, Miles Parkes, Christine Norton
{"title":"在 IBD 诊所讨论疼痛问题时，患者和临床医生有不同的侧重点。","authors":"Danielle Huisman, Esther Andrews, Amanda C de C Williams, Miles Parkes, Christine Norton","doi":"10.1136/bmjgast-2024-001540","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.3000,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529742/pdf/","citationCount":"0","resultStr":"{\"title\":\"Patients and clinicians have different priorities when discussing pain in the IBD clinic.\",\"authors\":\"Danielle Huisman, Esther Andrews, Amanda C de C Williams, Miles Parkes, Christine Norton\",\"doi\":\"10.1136/bmjgast-2024-001540\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.</p>\",\"PeriodicalId\":9235,\"journal\":{\"name\":\"BMJ Open Gastroenterology\",\"volume\":\"11 1\",\"pages\":\"\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-10-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529742/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMJ Open Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/bmjgast-2024-001540\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/bmjgast-2024-001540","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Patients and clinicians have different priorities when discussing pain in the IBD clinic.
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.
期刊介绍：
BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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