April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: Non-Pharmacologic Pain Management Options for Cancer In-Patients: A Qualitative Study of Stakeholder Perspectives
Purpose: In 2018 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued standards that require US hospitals provide non-pharmacologic pain treatment options as part of inpatient care. Despite JCAHO requirements and clinical evidence that supports non-pharmacologic approaches, pain management in hospitals primarily relies on medications. One way to provide non-pharmacologic options is through providing complementary and integrative therapies (CIH). This study reports from the qualitative arm of a larger hybrid effectiveness-implementation randomized clinical trial (RCT) of adjunctive acupuncture and pain counseling for inpatient cancer pain. We highlight stakeholder voices presenting patient, caregiver, and clinician perspectives on available treatments, preferences and potential barriers for integrating non-pharmacologic pain management approaches in hospital settings. Methods: Two groups of stakeholders with inpatient pain management experience were interviewed using semi-structured guides: staff from 14 US hospitals working in cancer, palliative care, pain management, and integrative medicine; and patients/caregivers from diverse sociodemographic backgrounds who had experiences with cancer-related hospitalization. Interviews were conducted on Zoom in English or Spanish and professionally transcribed/translated. Using inductive and deductive thematic analysis, we developed met as a team regularly to reconcile coding differences. Results: Seventy-five interviews were completed with 35 hospital staff, 31 patients, and 9 caregivers. All stakeholders spoke of the benefits of non-pharmacologic options not just for physical pain, but for treating pain as a “biopsychosocial” experience. Clinicians used this terminology whereas patients and caregivers spoke about “physical” and “emotional” aspects of the hospital experience. For many patients and caregivers, although they would have wanted to be offered CIH options, in the interviews, these weren’t always on the top of mind. For those that received CIH, those delivered by trained practitioners were valued in combination with biomedical pain treatments. However, participants reported that access to CIH was limited in most settings and not necessarily considered part of high-quality inpatient pain care. Reasons for this included lack of insurance reimbursement or other funding, limited institutional commitment to integration of CIH, research studies as the only form of access to CIH, and COVID, which limited access even in the most robust programs. Stakeholders, whether they had access to CIH in the hospital or not, all demonstrated a high degree of openness to CIH as part of inpatient pain management. Clinicians described it as adding “tools” to their toolkit. Patients brought up different issues than hospital staff with patients demonstrating more variation in preferences for how CIH should be implemented including a number of suggestions for how CIH options should be communicated with patients/caregivers, by whom, when, and how. Conclusions: Inpatient CIH for pain was not widely available despite increased evidence for the benefits of specific treatments and generally positive attitudes from stakeholders. This dearth of options was especially apparent in the ways that patients and caregivers answered questions about what their ideal pain management experience would be like. Despite overall positivity for CIH options to serve as non-pharmacological options for pain, funding and practical barriers still exist for more widespread implementation of inpatient CIH services.