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。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY BMJ Open Gastroenterology Pub Date : 2024-10-29 DOI:10.1136/bmjgast-2024-001540
Danielle Huisman, Esther Andrews, Amanda C de C Williams, Miles Parkes, Christine Norton
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引用次数: 0

摘要

目的:炎症性肠病(IBD)中的疼痛经常被忽视/忽视,尤其是溃疡性结肠炎患者,而且有关疼痛的交流可能不够理想。本研究将临床医生对患者疼痛的概念与患者的叙述并列起来。目的是为疼痛报告工具的开发提供信息,并为更好地交流 IBD 疼痛提供指导:对英国 13 名 IBD 临床医生进行了深入的半结构式访谈,其中包括胃肠病学家(5 人)、结直肠外科医生(2 人)、专科护士(4 人)和心理学家(2 人)。根据反思性主题分析的原则,对这些数据进行了初步分析,并对临床医生(人数=12)和患者(人数=71)就 IBD 疼痛问题进行的早期访谈进行了二次分析。对不同参与群体的主题进行了比较:结果:临床医生表示,他们会定期询问克罗恩病患者的疼痛情况,但不会询问溃疡性结肠炎患者的疼痛情况。然而,患者对两种疾病中疼痛的关注程度不一致,他们的疼痛报告受到权力的制约。一些临床医生承认,他们认为患者能够独立处理自己的疼痛,从而导致随访不足(主题 1:讨论 IBD 患者疼痛时的矛盾和模糊之处)。临床医生对疼痛认识不足的原因是时间限制和系统性问题。在缺乏炎症或结构性病因的情况下,一些临床医生默认将疼痛归咎于肠易激综合征,从而导致患者感到无人关心(主题 2:治疗疼痛的工具和时间有限的后果)。一些患者不愿表达不适或疼痛,另一些患者则回避可能导致疼痛的活动,这使得疼痛问题的解决变得更加复杂(主题 3:解决无主诉患者的疼痛问题):本研究强调了持续进行疼痛评估和管理的重要性,提倡临床医生和患者之间进行更开放的对话。
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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.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
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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