Facilitating Evidence-Based Practice Assignment | Custom Assignment Help

Prepare a brief (no more than 12 slides) PowerPoint presentation to disseminate the findings of the provided article to your fellow students or colleagues in your practice area or to another group who would be interested in this research such as clients or patients. This is your target audience. The content of your presentation must include – a title page indicating the title of the presentation, who the presenter is (you) and your credentials. If the title of your presentation is the title of the article then a footer may be used on this slide to reference the authors and year. Next, identify your target audience, the title and reference for the article, why you selected this research article, the research problem/question and/or purpose, whether the study uses a qualitative or quantitative approach, how the researcher(s) to address ethical considerations, major findings of the study, and the value of the article to evidence-based practice. Your assignment will also be graded for APA including a reference list, conciseness, creativity, design (slides not over crowded with text), consistency in terms of font size, style, titles etc., and grammar and spelling

Tell me your dreams and goals: Structuring communication exchanges to
improve patient-centered care with chronic pain patients☆
Karin L. Becker (PhD)
United States Air Force Academy, United States of America
A R T I C L E I N F O
Keywords:
Provider-patient communication
Chronic pain
Patient-centered care
Pain management
Computer mediated communication
A B S T R A C T
Background: Communicating pain is a difficult endeavor due to the lack of observable pathology, the immeasurable
nature of pain, and the presence of comorbid symptoms. While research has shown the value of curecentered
and care-centered communication, it is unclear how chronic pain patients would like to structure pain
communication with their providers so that it produces pain disclosure and emotional support.
Aim
This study examines communication preferences of chronic pain patients including types of questions asked
and information received to allow a holistic portrayal of the experience of living with chronic pain.
Design: The research used a quantitative survey that was disseminated via online chronic pain devoted support
groups.
Participants: 192 respondents took the survey, with women respondents outnumbering men at a 4:1 ratio.
Respondents came from 38 states and represented eight countries.
Results: For providers to better understand patients’ chronic pain, results indicate they would like providers to
inquire about how pain impacts their daily activities, relationships, work responsibilities, and goals and dreams
using open-ended questions. These low-stake questions can facilitate emotional disclosure, increase feelings of
support, and allow for co-morbid linkages.
Conclusion: These inquiries prioritize patients’ own subjective knowledge, can deepen the communication exchange
between provider and patient, and facilitate pain disclosure. The findings help to deliver patient-centered
care, promote rapport, and foster trust between providers and their patients.
1. Introduction
1.1. Background
Pain that is persistent, of considerable duration lasting more than 3
to 6 months, and which adversely affects a patient’s well-being, level of
function, and quality of life is termed chronic pain (Merskey & Bogduk,
1994). The most common sources of chronic pain stem from back pain,
joint pain, sinus pain, migraines, or pain from an injury and in the U.S.
population, women and seniors are more likely to have chronic pain
(Johannes, Le, Zhou, Johnston, & Dworkin, 2010). Chronic pain is a
common, confusing, and costly health care problem. It is linked to
limited mobility and activities, increases in anxiety and depression, loss
of productivity, and affects one-fifth of U.S. adults (Dahlhamer et al.,
2018). Additionally, the chronicity of symptoms for chronic pain
patients leads to more frequent contact and longitudinal relationships
with their providers (Matthias et al., 2010). Due to limited access to
providers who specialize in pain care, individuals with chronic pain are
often treated by their primary care providers who report frustration
when interacting with their chronic pain patients because of limited
time and expertise in pain management (Gatchel, McGeary, McGeary, &
Lippe, 2014; Matthias et al., 2010). Moreover, chronic pain patients
have widespread needs including clinical, social, and economic stressors
that hamper their quality of living (Dominick, Blyth, & Nicholasa,
2012). A holistic approach to treating chronic pain is needed, starting
with the initial communication.
The primary care provider-patient relationship has long been recognized
as central to strong patient care and positive health outcomes
(Brown, Stewart, & Ryan, 2003), with nurses and physicians as the two
most important providers in a clinical setting (Schneider, 2012). A
https://doi.org/10.1016/j.apnr.2020.151248
Received 14 November 2019; Received in revised form 28 February 2020; Accepted 3 March 2020
☆ Disclosure Information: This research was conducted and this manuscript was prepared solely by Karin L. Becker; no other researchers contributed to the research
or the writing. There is no conflict of interest presented in the form of money received, grants, consulting fees, speaker bureau, support for travel, payment for
writing, data analysis and interpretation, or any other relationship or compensation that could be construed as biasing or conflicting regarding this manuscript.
E-mail address: Karin.becker@usafa.edu.
Applied Nursing Research 53 (2020) 151248
0897-1897/ © 2020 Elsevier Inc. All rights reserved.
T
provider’s ability to diagnose and alleviate pain is contingent on the
opportunity and ability of sufferers to communicate their pain
(Narayan, 2010). However, numerous constraints impede communication.
As chronic pain is often invisible and inaudible and has no observable
physical pathology, a patient’s ability to accurately communicate
pain takes on a heightened role (Bendelow, 2013). Chronic pain’s
variable nature makes it difficult for sufferers to perceive and describe
their pain with exact communication which can lead to difficulties in
pain assessment and management (Shapiro & Teasell, 1997). A patient’s
faculties may be compromised by the sensation of pain and one’s speech
and thought process may be distorted by medications used to treat pain
(Birk, 2013). Additionally, chronic pain patients often have several
comorbidities, including depression, anxiety, sleep disturbances, fatigue,
and neurocognitive changes (Dahan, Van Velzen, & Niesters,
2014). These comorbidities impact the persistence of chronic pain yet
their vague symptoms are often dismissed or considered unrelated to
the pain syndrome (Dahan et al., 2014). Previous research has identified
that chronic pain patients complain of not being taken seriously or
having their claims dismissed (Leung, Arthur, & Udo, 2018). These
complaints highlight the need for improved ways to communicate pain.
1.2. Patient-centered communication
Research shows patients value both cure-centered communication
which prioritizes instrumental, cognitive, and task-focused behavior
and is associated with a provider’s competence as well as care-centered
communication which values affective and socio-emotional behavior
and establishes and maintains positive provider-patient relations (Ong,
de Haes, Hoos, & Lammes, 1995). For physicians, information is sought
to establish the right diagnosis and treatment plan (cure-centered); for
patients, information is needed to know and understand what is causing
the pain (cure-centered), as well as the need to feel known and understood
(care-centered) (Ong et al., 1995). While researchers are inconclusive
about which type of communication patients prefer (Roter,
Hall, & Katz, 1988), and some point out the overlap inherent in the two
in that informational communication can fulfill an emotionally supportive
function, successful therapeutic provider-patient relationships
consist of shared perceptions and feelings regarding the nature of the
problem (Ha & Longnecker, 2010). As most complaints about health
care providers pertain to communication issues, not clinical competency
(Tongue, Epps, & Forese, 2005), it is clear patients value skilled
diagnoses as much as skilled communicators (DiMatteo, 1995).
Within provider-patient communication, nurses in particular are at
the front lines of initial patient communication and liaise between patients
and providers (Wang et al., 2018). Their ability to identify and
appropriately asses pain and provide effective treatment is hinged on
initial intake communication. Research has identified several barriers
that impede pain assessment including lack of time with patients, inadequate
knowledge of pain management, and patients’ difficulty with
completing pain scales (Ayfer, Hanife, Gulay, & Kamer, 2011).
One strategy to foster productive communication is delivering patient-
centered care, which fosters open communication, cultivates patient
rapport, and is especially important in pain treatment (Tait, 2008;
Upshur, Bacigalupe, & Luckmann, 2010). Hallmarks of patient-centered
care are listening to and trusting patients, demonstrating empathy,
empowering patients to participate in their own care, and forging a
partnership with patients (Tait, 2008; Upshur et al., 2010). Patientcentered
care is fostered by open provider-patient communication so
that the needs and wants of the patients are understood and addressed
(Michie, Miles, & Weinman, 2003). Specifically, it was noted that patients
with chronic disease, including chronic pain, yearn for more
opportunities for participation and information sharing when interacting
with their providers (Suarez-Almazor, 2004).
While there is an abundance of literature studying provider-patient
communication, there is limited research focusing on communication
preferences among chronic pain patients. Little is known about what
types of questions would help elicit pain disclosure or the kinds of information
chronic pain patients would like their providers to offer.
Moreover, chronic pain provider-patient communicative interaction
can be strained because of the non-equal positions, the non-voluntary
context, and the inherent exigency of the nature of chronic pain (Ong
et al., 1995).
1.3. Aims
To capitalize on the interactions patients have with their providers
and deliver patient-centered care, there is a need to better understand
the communication preferences of chronic pain patients. By asking how
chronic pain patients would like to structure initial intake communication
including pain assessment, questions asked, and types of information
received, this research helps providers meet expectations,
offer support, and foster rapport.
2. Method
2.1. Survey design
A survey was disseminated on chronic pain devoted social media
websites to investigate how chronic pain impacts individuals with
chronic pain and their perceptual efficacy, benefits of, and patterns for
communicating their pain with friends and family as well as health care
providers. The survey consisted of twenty-six questions that were
grouped in the following themes: how chronic pain impacts their ability
to work and perform daily activities; with whom they talk about their
pain outside of their health care provider, how adequately they perceive
they can describe their pain; the perceived benefit of talking
about pain; the perceived interest from others in learning about their
chronic pain experience; and the perceived support they receive from
others when talking about their pain. Survey questions were multiple
choice in nature, with some questions directing respondents to choose
all that applied. Every question contained an “Other” selection whereby
respondents could write their own response. Textual responses were
reviewed and coded with an eye for emerging patterns.
2.2. Computer mediated communication
Utilizing computer mediated technology in health communication
has been a popular trend (Sillence, 2013; Ziebland & Wyke, 2012). The
readily available and accessible Internet technology caters to a population
where anonymity, confidentiality, and mobility issues abound
(Guillory et al., 2015). The ability to tap into established online support
groups has many benefits, such as breaking geographical distance between
persons who share the same disease and allowing discussions
over various taboo topics in an easier way with asynchronous communication
(Steadman & Pretorius, 2014; Klemm, Hurst, Dearholt, &
Tron, 1999). By overcoming space and distance, online support groups
can create a community which disregards physical boundaries and
immobility and “liberates individuals from social, geographical and
biological constraints of place and proximity” (Miller, 2011, p.191).
2.3. Recruitment procedures
Recruitment for survey respondents took on a clustering procedure
where an already established group of chronic pain sufferers was
identified and then sampled from within the group (Creswell, 2009).
Participants were recruited from chronic pain devoted social media
websites hosted on Facebook and Reddit. All of the Facebook sites were
privately maintained by individuals and not managed by organizations
or non-profits. These sites were selected due to their intent to serve as
educational and supportive outlets for people with chronic pain. From
all of the chronic pain social media sites, only the sites with active posts
and with followers exceeding 400 members were selected to increase
K.L. Becker Applied Nursing Research 53 (2020) 151248
2
the chances of survey completion from an engaged audience. Each
member of these groups had an equal opportunity of completing the
survey.
2.4. Target audience
Included with the survey was an informed consent which explained
the aims of the study, the voluntary nature of it, and the ethical measures
approved by the IRB. The first survey question asked if respondents
agreed to participate in the study. If respondents selected
“Yes” they proceeded to the following question. Skip logic prevented
respondents who selected “No-refuse” from continuing the survey.
To confirm this survey was reaching its intended audience of individuals
with chronic pain, the second survey question asked respondents
if they experience chronic pain. The survey did not ask the
cause of the chronic pain, so it is unknown if the sample of respondents
had chronic pain stemming from cancer, trauma or injury, or an underlying
chronic pain condition. Inclusionary criteria included respondents
self-identifying as having chronic pain. Since this survey is
aimed at better understanding communication preferences among individuals
with chronic pain, respondents who identified as having a
concealed disability that is commonly stigmatized conveys their identification
with a marginalized group (Jackson, 2005; Werner, Isaksen, &
Malterud, 2004). Skip logic took respondents who selected “No” they
“don’t experience chronic pain” to the end of the survey.
Moreover, the ways in which individuals with chronic pain perform
their pain through discursive practices is one way to better understand
how they construct their identity (Werner & Malterud, 2003). More
than delineating a clinically based sample of individuals with chronic
pain, this research seeks to add input from individuals who identify as
having chronic pain and capitalize on their expertise stemming from
their personal experience with pain (Richards, 2008).
2.5. Sample size and respondent characteristics
The total number of respondents to take the chronic pain communication
practices survey was 192 with 157 completing it in its entirety,
representing an 82% completion rate. Female respondents outnumbered
male respondents at an almost 4:1 ratio with 127 females
and 35 males indicating their gender. Overall, survey respondents were
young in age with a majority of respondents aged between 25 and
34 years of age (N = 54). The majority of respondents indicated the
racial category that best describes them is White (N = 145). Survey
respondents came from 38 states in the United States as well as from
eight foreign countries. Respondents represented an educated sample
with the majority having some college (N = 47) and a plurality having
a bachelor’s degree (N = 38) or masters, doctorate, or professional
degree (N = 32). These respondent characteristics are consistent with
Internet usage trends as identified by the Pew Research Center (2014)
Internet Project Survey. They align with chronic pain demographics
where women are more likely to experience chronic pain, however this
sample is much younger than national chronic pain demographics
where there is a higher prevalence of chronic pain associated with
advanced age (Dahlhamer et al., 2018).
3. Results & analysis
3.1. Chronic pain impacts
When asked how chronic pain impacts them, survey respondents
were told to select all that applied from the following options:
“Emotionally, Physically, Mentally, Financially, Spiritually,” and
“Other”. The majority of survey respondents indicated chronic pain
impacts them physically (99%, N = 176). Emotional and mental impacts
were tied for the second highest influence (93%; N = 165), followed
by financial (72%; N = 129), and then spiritual (28%; N = 50).
Seventeen respondents marked “Other” and sexual (N = 6) and social
(N = 5) were the most common responses. Other respondents said
chronic pain impacts them verbally, academically, was time consuming,
and “in every aspect of every second of my being.” These responses
provide insights into the myriad ways chronic pain impacts individuals
and highlights its influence beyond physicality.
When asked if pain disrupts their day-to-day living, the majority of
respondents indicated “Constantly” (51%; N = 90), followed by
“Frequently” (35%; N = 63), and “Occasionally” (16%; N = 28). Only
two respondents (1%) said pain “Rarely” disrupts daily living, and one
said pain “Never” (1%) disrupts daily living.
However, when asked whether they had to miss work or cancel a
social outing due to chronic pain, only 27% (N = 48) reported they
“Constantly” did. The majority of respondents reported they
“Frequently” did (37%; N = 66), followed by “Occasionally” (30%;
N = 53). Ten respondents (6%) indicated they “Rarely” miss work or
cancel social outings and four (2%) reported they “Never” do. Of the
seven respondents (4%) who marked “Other,” five claimed disability
and reported they “can no longer work.” One respondent explained “I
no longer work and my dreams, goals and the person I thought I was
going to be will never happen.”
Overall, the extent of chronic pain disrupting day-to-day living does
not seem to interfere with work or social commitments. Although half
of respondents indicated chronic pain “constantly” disrupts daily living,
only a quarter “constantly” miss work or social outings. This disconnect
could suggest that individuals with chronic pain work despite experiencing
pain, have normalized pain, and/or medicate to alleviate the
pain.
3.2. Ability to communicate chronic pain
When asked if respondents could adequately describe their pain,
almost two-thirds indicated some sort of agreement, with 19% (N=17)
expressing Strongly Agree and 43% (N = 64) expressing Agree.
However, the ability to communicate pain does not necessarily relate to
others understanding the experience of pain. Half of respondents indicated
some sort of disagreement when asked if they felt their health
care provider understands their pain when they describe it. The comparison
between perceived ability to describe pain and perception that
their health care provider understands their pain when they describe it
are shown in Fig. 1.
The perception that health care providers understand how pain
impacts their life was almost evenly split, with 52% indicating some
form of agreement. Textual responses shed light on some of the tension
between communicating and understanding.
• “Because I have a hard time explaining it, and I tend to downplay
it.”
• “Do they care or am I whiner?”
• “Until you walk in other people’s shoes you don’t know what their
pain feels like.”
• “Primary doctor believes but does not understand. Most doctors do
not understand.”
• “They don’t understand the disease enough to understand how to
help.”
• “My general practitioner is very empathetic, but I don’t think they
truly understand.”
3.3. Pain communication and perceived support
Slightly more than half (54%) of chronic pain patients indicated
some form of agreement with the statement they feel supported and
understood when they talk about their pain with their health care
provider. Textual responses reinforce the tension between supporting
and understanding.
K.L. Becker Applied Nursing Research 53 (2020) 151248
3
• “Supported—yes. Understood—no.”
• “Doctors don’t hand hold or empathize.”
• “When I talk to my husband, yes. When talking to Dr’s, no.”
• “They hear it all the time. They don’t care about me.”
3.4. Preferred questions from health care providers
To enable respondents to discuss how living with chronic pain impacts
them, the following survey question was posed: “To better understand
my chronic pain, I wish my health care provider would ask me
more about how chronic pain impacts my…” Respondents had seven
areas of impact to choose from including: “Daily activities; Social and
family relationships; Work responsibilities; Self-esteem; Goals and
dreams; Nothing, I don’t want to talk to them about any of these; and
Other.” Respondents could choose all areas of impact that applied.
Three quarters (77%; N = 125) of all respondents indicated they
would like their health care provider to ask them about how pain impacts
their daily activities. Two-thirds of respondents (68%; N = 110)
selected they wanted providers to inquire about how pain impacts their
social and family relationships, followed by how pain impacts their
work responsibilities (63%; N = 102), goals and dreams (61%;
N = 99), and self-image and self-esteem (57%; N = 93). Only 2% of
respondents (N = 4) selected they didn’t want to talk to their health
care provider about any of these. Textual responses indicate specific
areas of impact including:
• “my sleep.”
• “depression.”
• “other aspects of my health.”
• “adaptations I could use i.e. read out loud software on computers.”
• “impacts my whole life.”
3.5. Preferred information from health care providers
Survey results reveal that when individuals with chronic pain talk
with their health care provider, respondents prioritize receiving information
over validation and emotional support. Survey respondents
ranked five areas of importance using a scale of 1 representing little
importance and 5 representing great importance. Respondents overwhelmingly
ranked receiving “information about their treatment plan”
as their number one priority (4.31), followed by receiving “information
about their chronic pain condition” (3.96). Receiving “empathy regarding
the debilitating impacts of chronic pain” was ranked third
(3.84). The “opportunity to talk about pain using their own words”
ranked fourth (3.69) and “support for their emotional well-being” was
ranked fifth (3.58).
4. Discussion: patient-centered pain communication
This study examined provider-patient communication preferences
among chronic pain patients. With the majority of respondents indicating
there is benefit in pain communication, it is important to note
that talking about pain does not yield feelings of support. The difference
between describing pain and gaining emotional support is an important
distinction as it points out that language is not a barrier. Structural
constraints for the expression of pain are not hindering pain communication;
rather, pain expression is limited by the audience’s lack of
empathy, inability to relate, or understand its vast impacts. These
findings reinforce the feelings of loneliness and isolation felt by chronic
pain patients (Leung et al., 2018) and add to our understanding of
patient-provider communication by highlighting the extent chronic
pain patients rely on providers to gain emotional support and validation
when they talk about pain. This value on care-centered communication
sheds light on previous studies (Ong et al., 1995) and underlines the
importance of providers’ communication skills and non-judgmental
approach (Butow & Sharpe, 2013).
This study helped to identify how providers can structure pain
communication to better provide patient-centered care. Given that half
of the respondents indicated their health care provider did not understand
their pain when they described it, a shift in pain communication
is needed. Additionally, it is important to note that patients’ perceived
ability to describe pain does not lead to them feeling emotionally
supported. Results suggest chronic pain patients want to de-emphasize
descriptions of the pain and emphasize the way pain impacts their daily
activities, relationships, work responsibilities, and goals and dreams.
For example, asking them to describe their day, including their ability
to get dressed, do housework, perform at work, and go out with friends
puts the focus on function, not feeling. This line of inquiry allows patients
to give a holistic account of the emotional and mental aspects of
living with chronic pain and may allow better linkages to comorbid
symptoms (Dahan et al., 2014). In turn, these insights can help nurses
serve as a liaison by sharing relevant information to physicians and
advocating for patient care (Wang et al., 2018).
Key to the success of patient-centered pain disclosure is engaging in
spontaneous communication, where providers may ask patients informal,
open-ended questions. Research has shown spontaneous communication
builds bonds, (Nardi & Whittaker, 2002) and enables information
to flow more fluidly (Kiesler & Cummings, 2002). Asking
0
10
20
30
40
50
60
70
Strongly Agree Agree Disagree Strongly Disagree Other
Ability to Describe Pain vs. Perception of
Health Care Providers Understanding Pain
( N=149)
I can adequately describe pain I feel that health provider undestands my pain when I describe it
Fig. 1. Ability to describe pain.
K.L. Becker Applied Nursing Research 53 (2020) 151248
4
unscripted questions, ones that don’t need to be deep or pertaining to
the pain, but that make a human connection and position the provider
as a listener is another recommendation (Gawande, 2007). For example,
providers can ask patients what their dreams or goals are and
then ask how their pain impacts their ability to achieve them. These
types of low-stakes questions prioritize patients’ subjective knowledge
and lived experiences (Belenky, Clinchy, Goldberger, & Tarule, 1986).
Previous research has shown the phrasing of pain questioning
matters, with open-ended questions eliciting significantly more details
than close-ended (McDonald, Shea, Rose, & Fedo, 2009). Further, the
timing of when open-ended questions are asked influences responses.
Using open-ended questions, in conjunction with pain assessment scales
like the Brief Pain Inventory Short Form, have indicated a significant
increase in the amount of reported functional pain interference by older
adult pain patients when the open-ended questions were discussed
before completing the Short Form (McDonald et al., 2008). Additionally,
general conversational questions providers ask (i.e. “How
are you feeling?”) may influence patients to respond in a positive, socially
desirable way and suppress their pain (McDonald, McNulty,
Erickson, & Weiskopf, 2000).
Patients who have the opportunity to openly communicate their
pain with their provider in a holistic way, without interruption, improve
pain outcomes, have an increased sense of self-efficacy and
confidence in their health outcomes (McDonald & Fedo, 2009; Stewart
et al., 2000; Teutsch, 2003), and report enhanced therapeutic alliances,
increased patient agency, and empowerment (Street Jr., Makoul, Arora,
& Epstein, 2009). Moreover, it positions patients as active respondents.
Prior research has positioned patients as passive, with providers setting
the agenda and regulating topics (Beach, 2013; Heritage & Maynard,
2006). While providers are still posing the questions, the change in the
nature of questioning elicits patients to offer emotional responses. Research
has indicated providers respond with higher levels of affect and
are more likely to offer partnerships with patients when hopeful questions
were asked (Beach & Dozier, 2016).
The opportunity for chronic pain sufferers to speak openly with
their health care providers may suggest changes to the process of the
provider-patient interview commonly practiced in western medicine,
shifting it from a dialogue which resembles a question and answer
format, to a dialectic mode where patients are empowered to tell their
own pain story. This type of pain communication does not focus on
pragmatic information, but on intersubjective disclosure of vulnerability
and emotional disclosure (van Hooft, 2003). Moreover, the
questions posed can help patients process their emotions and as results
indicate, reflect on how pain affects them not only physically, but also
emotionally, mentally, financially, spiritually, and sexually.
Applying a social constructivist theoretical approach enables patients
to be active contributors in the communication exchange where
they are empowered to share, understand, and make meaning together
with their providers (Berger & Luckman, 1966). By allowing patients to
talk in their own words and by responding with empathy, providers are
bridging the gap between themselves as physicians and their patients as
“othered” individuals (Butler, 1993). As previous research has demonstrated,
patients who feel listened to and believed in experience
mutual trust (Gsesdal, Dysvik, & Furnes, 2018) and report higher patient
satisfaction, have higher treatment adherence, and change physicians
less frequently (Butow & Sharpe, 2013; Maguire & Pitceathly,
2002; Tongue et al., 2005; Stewart et al., 2000; Wright et al., 2006).
However, the impact of this particular line of inquiry has on improving
health outcomes has not been tested.
5. Limitations
The voluntary sample of this research has four limitations. First,
survey completion rates may be curbed by those who are disinterested
or unwilling to participate in an online survey. Disseminating a survey
using computed mediated communication excludes those not inclined
to use the Internet or those who do not have access to it. This limitation
has specific implications for older persons who did not grow up in the
digital culture and are less likely to adopt to Internet communication
practices. Second, the explicit invitation for respondents to complete
the survey to better investigate chronic pain’s impacts may bring into
play the Hawthorne effect, where respondents may exaggerate their
responses because they know research is being conducted. Third, responses
were self-reported and are therefore subject to recall bias.
Finally, the wording of survey questions inquiring about individuals’
communication preferences with their health care provider was problematic
in that individuals with chronic pain often have multiple
doctors. Answers may vary widely depending on which provider respondents
were thinking of. Future survey questions should be narrowed
down to specify “primary health care provider” to avoid confusion.
These constraints may undermine the integrity of the research and
limit the generalizability of findings.
6. Conclusion
This research adds clinical value by identifying chronic pain patients’
preferences for communicating with health care providers. This
study indicates the desired prompts that will facilitate pain disclosures
and help patients communicate the holistic impacts of living with
chronic pain. Delivering patient-centered care needs to start with customizing
communication to meet patients’ priorities. It is recommended
providers inquire how pain impacts their patients’ daily activities, relationships,
and work responsibilities by using open-ended questions
(McDonald et al., 2008, 2009). Facilitating pain disclosure can positively
impact pain assessment, patient rapport, and treatment adherence
(Maguire & Pitceathly, 2002; Tait, 2008; Upshur et al., 2010).
Attending to patient-specific communication practices is one way providers
can deliver personalized treatment and empower patients to
develop their pain communication.
Declaration of competing interest
None.
References
Ayfer, E., Hanife, M., Gulay, E., & Kamer, M. (2011). Nurses’ perceived barriers to assessment
and management of pain in a university hospital. Journal of Pediatric
Hematology/Oncology, 33, S33–S38.
Beach, W. A. (2013). Patients’ efforts to justify wellness in a comprehensive cancer clinic.
Health Communication, 2013(28), 577–591.
Beach, W. A., & Dozier, D. M. (2016). Fears, uncertainties, and hopes. Patient-initiated
actions and doctors’ responses during oncology interviews. Journal of Health
Communication, 20(11) 1443–1254.
Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1986). Women’s ways of
knowing: The development of self, voice, and mind. New York: Basic Books.
Bendelow, G. (2013). Chronic pain patinets and the biomedical model of pain. The Virtual
Mentor, 15(5), 455–459.
Berger, P. L., & Luckman, T. (1966). The social construction of reality: A treatise in the
sociology of knowledge. London: Penguin.
Birk, L. B. (2013). Erasure of the credible subject: An autoethnographic account of chronic
pain. Cultural Studies, Critical Methodologies, 1–10. https://doi.org/10.1177/
1532708613495799.
Brown, J. B., Stewart, M., & Ryan, B. L. (2003). Outcomes of patient–Provider interaction.
In T. L. Thompson, A. M. Dorsey, K. I. Miller, & R. Parrott (Eds.). Handbook of health
communication (pp. 141–161). Mahwah, NJ: Erlbaum.
Butler, J. (1993). Bodies that matter: On the discursive limits of ‘sex’. London, Routledge.
Butow, P. & Sharpe, L. (2013). The impact of communication on adherence in pain
management. Pain, 154(1), S101–S107.
Butow, P., & Sharpe, L. (2013). The impact of communi cation on adherence in pain
management. Pain, 154(1), S101–S107.
Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches
(3rd ed.). Thousand Oaks, CA: Sage.
Dahan, A., Van Velzen, M., & Niesters, M. (2014). Comorbidities and the complexities of
chronic pain. Anesthesiology, 121(4), 675–677.
Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., … Helmick, C.
(2018). Prevalence of chronic pain and high-impact chronic pain among
adults—United States, 2016. Retrieved from Centers for Disease Control and
Preventionhttps://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm.
K.L. Becker Applied Nursing Research 53 (2020) 151248
5
DiMatteo, M. R. (1995). The role of the physician in the emerging health care environment.
Western Journal of Medicine, 168(5), 328–333.
Dominick, C., Blyth, F., & Nicholasa, M. (2012). Unpacking the burden: Understanding
the relationships between chronic pain and comorbidity in the general population.
Pain, 153, 259–260.
Gatchel, R. J., McGeary, D., McGeary, C., & Lippe, B. (2014). Interdisciplinary chronic
pain management: Past, present and future. American Psychologist, 69(2), 119–130.
Gawande, A. (2007). Better: A surgeon’s note on performance. New York: Picador.
Gsesdal, K., Dysvik, E., & Furnes, B. (2018). Living with chronic pain: Patients’ experiences
with healthcare services in Norway. Nursing Open, 5(4), 517–526.
Guillory, J., Chang, P., Henderson, C. R., Jr., Shengelia, R., Lama, S., Warmington, M.,
Reid, M. C., et al. (2015). Piloting a text message-based social support intervention
for patients with chronic pain: Establishing feasibility and preliminary efficacy.
Clinical Journal of Pain, 31(6), 548–556. https://doi.org/10.1097/AJP.
0000000000000193.
Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: A review. The Ochsner
Journal, 10(1), 38–43.
Heritage, J., & Maynard, D. (Eds.). (2006). Communication and medicine: Talk and action in
primary care consultations. Cambridge: Cambridge University Press.
Jackson, J. E. (2005). Stigma, liminality, and chronic pain—Mind-body borderlands.
American Ethnologist, 32, 332–353.
Johannes, C. B., Le, T. K., Zhou, X., Johnston, J. A., & Dworkin, R. H. (2010). The prevalence
of chronic pain in United States adults: Results of an internet-bases survey.
The Journal of Pain, 11(11), 1230–1239.
Kiesler, S., & Cummings, N. (2002). What do we know about proximity and distant in
work groups? In P. J. Hinds, & S. Kiesler (Eds.). Distributed work. Cambridge, MA: MIT
Press.
Klemm, P., Hurst, M., Dearholt, S., & Tron, S. (1999). Cyber solace: Gender differences on
internet cancer support groups. Computers in Nursing, 17, 65–72.
Leung, K., Arthur, R., & Udo, I. (2018). Patients’ perspective on management of chronic
pain associated with frequent emergency attendances and psychiatric diagnoses.
Journal of Patient Experience, 6(3), 179–184.
Maguire, P., & Pitceathly, C. (2002). Key communication skills and how to acquire them.
British Medical Journal, 325(7366), 697–700.
Matthias, M. S., Parpart, A. L., Nyland, K. A., Huffman, M. A., Stubbs, D. L., Sargent, C., &
Blair, M. J. (2010). The patient-provider relationship in chronic pain: Providers’
perspectives. Pain Medicine, 11, 1688–1697.
McDonald, D. D., & Fedo, J. (2009). Older adults’ pain communication: The effect of
interruption. Pain Management Nursing, 10(3), 149–153.
McDonald, D. D., McNulty, J., Erickson, K., & Weiskopf, C. (2000). Communicating pain
and pain management needs after surgery. Applied Nursing Research, 13(2), 70–75.
McDonald, D. D., Shea, M., Fedo, J., Rose, L., Bacon, K., Noble, K., & Stewart, J. (2008).
Older adult pain communication and the brief pain inventory short form. Pain
Management Nursing, 9(4), 154–159.
McDonald, D. D., Shea, M., Rose, L., & Fedo, J. (2009). The effect of pain questioning
phrasing on older –adult pain information. Journal of Pain and Symptom Management,
37(6), 1050–1060.
Merskey, H., & Bogduk, N. (1994). Classification of chronic pain (2nd ed.). Seattle: IASP
Press.
Michie, S., Miles, J., & Weinman, J. (2003). Patient-centeredness in chronic illness: What
is it and does it matter? Patient Education and Counseling, 51(3), 197–206.
Miller, V. M. (2011). Understanding digital culture. Thousand Oaks, CA: Sage Publications.
Narayan, M. C. (2010). Culture’s effects on pain assessment and management. American
Journal of Nursing, 110(4), 38–47.
Nardi, B., & Whittaker, S. (2002). The place of face-to-face communication in a distributed
network. In P. J. Hinds, & S. Kiesler (Eds.). Distributed work. Cambridge, MA:
MIT Press.
Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., & Lammes, F. B. (1995). Doctor-patient
communication: A review of the literature. Social Science & Medicine, 40(7), 903–918.
Pew Research Center (2014). Internet project: Internet user demographics. Retrieved
from http://www.pewinternet.org/data-trend/internet-use/latest-stats/.
Richards, R. (2008). Writing the othered self: Autoethnography and the problem of objectification
in writing about illness and disability. Qualitative Health Research, 18,
1717–1728.
Roter, D. L., Hall, J. A., & Katz, N. R. (1988). Patient physician communication: A descriptive
summary of the literature. Patient Education and Counseling, 12, 99–119.
Schneider, M. A. (2012). Nurse-physician collaborations: Its time has come. Nursing,
42(7), 50–53.
Shapiro, A. P., & Teasell, R. W. (1997). Misdiagnosis of chronic pain as hysterical.
Neuropsychological Rehabilitation, 8(3), 201–222.
Sillence, E. (2013). Giving and receiving peer advice in an online breast cancer support
group. Cyberpsychology, Behavior and Social Networking, 16(6), 480–485.
Steadman, J., & Pretorius, C. (2014). The impact of an online Facebook support group for
people with multiple sclerosis on non-active users. African Journal of Disability, 3(1),
132.
Stewart, M., Brown, J. B., Donner, A., McWhinney, I. R., Oates, J., Weston, W. W., &
Jordan, J. (2000). The impact of patient-centered care on outcomes. Journal of Family
Practice, 49(9), 796–798.
Street, R. L., Jr., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication
heal? Pathways linking clinician-patient communication to health outcomes.
Patient Education and Counseling, 74(3), 295–301.
Suarez-Almazor, M. (2004). Patient-physician communication. Epidemiology and Health-
Related Services, 16(2), 91–95.
Tait, R. C. (2008). Empathy: Necessary for effective pain management? Current Pain and
Headache Reports, 12, 108–112.
Teutsch, C. (2003). Patient-doctor communication. The Medical Clinics of North America,
87(5), 1115–1145.
Tongue, J. R., Epps, H. R., & Forese, L. L. (2005). Communication skills for patient-centered
care: Research-based, easily learned techniques for medical interviews that
benefit orthopaedic surgeons and their patients. Journal of Bone and Joint Surgery
(American), 87, 652–658.
Upshur, C. C., Bacigalupe, G., & Luckmann, R. (2010). “They don’t want anything to do
with you”: Patients views of primary care management of chronic pain. Pain Medicine,
11(12), 1791–1798.
van Hooft, S. (2003). Pain and communication. Medicine, Health Care and Philosophy, 6(3),
255–262.
Wang, Y., Wan, Q., Guo, J., Jin, X., Zhou, W., Feng, X., & Shang, S. (2018). The influence
of effective communication, perceived respect and willingness to collaborate on
nurses’ perceptions of nurse-physician collaboration in China. Applied Nursing
Research, 4, 73–79.
Werner, A., Isaksen, L., & Malterud, K. (2004). “I am not the kind of woman who complains
of everything”—Illness stories on self and shame in women with chronic pain.
Social Science & Medicine, 59, 1035–1045.
Werner, A., & Malterud, K. (2003). It is hard work behaving as a credible patient:
Encounters between women with chronic pain and their doctors. Social Science &
Medicine, 57(8), 1409–1419.
Wright, K. B., Bylund, C., Ware, J., Parker, P., Query, J. L., & Baile, W. (2006). Medical
student attitudes toward communication skills training and knowledge of appropriate
provider-patient communication: A comparison of first-year and fourth-year medical
students. Medical Education, 11(18), 1–10.
Ziebland, S., & Wyke, S. (2012). Health and illness in a connected world: How might
sharing experiences on the internet affect people’s health? The Milbank Quarterly,
90(2), 19–49. https://doi.org/10.1111/j.1468-0009.2012.00662.
K.L. Becker Applied Nursing Research 53 (2020) 151248
6