Background & Aims

In Canada, chronic pain (CP) patients are mainly treated by primary care providers. However, the clinical management of CP is complicated by inadequate continuing interprofessional development across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts (NASEM, 2019; Thompson et.al., 2018). Pain education for health professionals is needed for improving and enabling prevention and treatment practices. Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain. (Wideman et. al., 2019b). With the release of Canadian and provincial recommendations, there is an impetus to understand the knowledge gaps faced by primary care providers. The aim of this study is to elicit primary care providers’ views about enhancing knowledge of healthcare professionals in the assessment of pain management to provide effective CP care.

Methods

An explanatory sequential mixed-methods design was used to identify knowledge gaps and determine learning objectives for online learning modules to equip primary care providers in Quebec with the necessary competencies to manage adult chronic pain in rural and urban areas. Using a provincial database of primary care providers, we conducted a cross-sectional online survey (N-450) of continuing interprofessional development needs and perceived knowledge. Results from the survey were used to inform semi-structured focus-group interviews to determine preferred learning objectives. The focus groups (N=3) were conducted with a convenience sample of primary care providers from urban and rural areas who had completed the survey (N=22). Data were analyzed (April 2023 – September 2023) using content analysis and categorized in themes and subthemes. Results were shared independently with participants to verify the accuracy and relevancy of the data prior to knowledge dissemination.

Results

Survey respondents were primarily nurses (43%), physiotherapists (13%) and social workers (22%), university educated (90%), working in primary care clinics (92%). Most respondents (80%) had not received any form of training in the last 3 years, with over 50% self-identifying as beginners in the areas of neuroplasticity, assessment and treatment of pain, organization of service delivery, management of patient trajectories, and continuity and coordination of care. Five themes and 14 subthemes focused on learning priorities emerged from the thematic analysis: whole-person care (assessment, pharmacological and nonpharmacological approaches, neuroplasticity); interdisciplinary integrated care (interdisciplinary care, provider roles, principles of integration, care coordination, care transitions, organization of care trajectories); digitally-enabled care; patients’ roles (shared decision-making, self-management); vulnerable populations (Immigrants, Indigenous people); and barriers to care.

Conclusions

Primary care providers shared their perspectives on knowledge gaps in managing CP including broader systemic priorities. Primary care providers require greater access to continuing interprofessional development to build knowledge and confidence in pain management and care delivery using patient-centred approaches. The next phase of the project is to co-design, with patients and primary care providers, asynchronous modules in interprofessional CP management that provide comprehensive knowledge aligned with best practices and learners’ needs. This collaborative approach will integrate an equity-based lens, ensuring modules are culturally responsive and inclusive. Finally, the notion of interdisciplinarity will be integrated across all modules to balance socialization within and across professional and organizational boundaries, enhance knowledge among different health professions and facilitate the implementation of gold-standard care, mainly team-based and collaborative care.

References

National Academies of Sciences, Engineering, and Medicine (NASEM). (2019). The role of
nonpharmacological approaches to pain management: Proceedings of a workshop. The National
Academies Press.

Thompson, K., Johnson, M. I., Milligan, J., & Briggs, M. (2018). Twenty-five years of pain education
research-what have we learned? Findings from a comprehensive scoping review of research into
pre-registration pain education for health professionals. Pain, 159(11), 2146-2158.

Wideman, T. H., Miller, J., Bostick, G., Thomas, A., Bussières, A., & Wickens, R. H. (2019b). The current
state of pain education within Canadian physiotherapy programs: A national survey of pain
educators. Disability and Rehabilitation

Ogrinc G, Davies L, Goodman D, et al. (2016). SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Quality Safety, 25:986–992.

Presenting Author

Regina Visca

Poster Authors

Regina Visca

OTHR

McGill University Health Centre , Montreal, Quebec, Canada

Lead Author

Claire Nehme

CIUSSS Ouest-de-l'Ile de Montréal, Quebec, Canada

Lead Author

Sindiane Bouchaala

CIUSSS Ouest-de-l'Ile de Montréal, Quebec, Canada

Lead Author

Sabrina Mitrovic

McGill RUISSS Centre of Expertise in Chronic Pain, Montreal, Quebec, Canada

Lead Author

Mylène Laberge-Homsy

CIUSSS Ouest-de-l'Ile de Montréal, Quebec, Canada

Lead Author

Sandra Gaudet-Menard

McGill University Health Centre , Montreal, Quebec, Canada

Lead Author

Krista Brecht

McGill University Health Centre , Montreal, Quebec, Canada

Lead Author

Topics

  • Education