The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study

BackgroundPostoperative pain remains a challenge in the developed world, but the consequences of inadequately treated postoperative pain are particularly severe in low- and middle-income countries. Since 2011, reports have drawn attention to the poor quality of postoperative pain management in Ethiopia; however, our multicenter qualitative study was the first to attempt to understand the factors that are barriers to and facilitators of quality pain managment in the country. To this aim, the study explored the perspectives of patients, healthcare professionals, and hospital officials. We expected that the results of this study would inform strategies to improve the provision of quality pain management in Ethiopia and perhaps even in other low- and middle-income countries.MethodsThis study used a qualitative, descriptive approach in which nine healthcare professionals, nine patients, and six hospital officials (i.e. executives in a managerial or leadership position in administration, nursing, or education) participated in face-to-face, semi-structured interviews. Thematic data analysis was conducted, and patterns were explained with the help of a theoretical framework.FindingsThe barriers identified ranged from healthcare professionals’ lack of empathy to a positive social appraisal of patients’ ability to cope with pain. They also included a lack of emphasis on pain and its management during early medical education, together with the absence of available resources. Enhancing the ability of healthcare professionals to create favorable rapport with patients and increasing the cultural competence of professionals are essential ingredients of future pain education interventions.ConclusionsBarriers to and facilitators of postoperative pain management do not exist independently but are reciprocally linked. This finding calls for holistic and inclusive interventions targeting healthcare professionals, patients, and hospital officials. The current situation is unlikely to improve if only healthcare professionals are educated about pain physiology, pharmacology, and management. Patients should also be educated, and the hospital environment should be modified to provide high-quality postoperative pain management.

研究背景：术后疼痛在发达国家仍是一项临床难题，而术后疼痛治疗不充分所带来的不良后果在中低收入国家尤为严重。自2011年起，已有多篇报道关注埃塞俄比亚术后疼痛管理质量低下的问题，但本团队开展的这项多中心定性研究，首次尝试探明该国优质疼痛管理的阻碍因素与促进因素。为此，本研究调研了患者、医护人员及医院管理人员的视角。我们期望本研究结果可为埃塞俄比亚乃至其他中低收入国家优化术后疼痛管理服务提供策略参考。
研究方法：本研究采用定性描述性研究方法，共纳入9名医护人员、9名患者及6名医院管理人员（即行政管理、护理或教育领域具备管理或领导岗位的行政人员），并对其开展面对面半结构化访谈。研究采用主题数据分析方法，并借助理论框架阐释数据中的内在模式。
研究结果：本研究识别的阻碍因素涵盖医护人员缺乏同理心、对患者疼痛耐受能力的正向社会评价，以及早期医学教育中对疼痛及其管理的重视不足，同时还包括可用医疗资源匮乏。未来的疼痛教育干预措施，需以提升医护人员与患者建立良好融洽关系的能力，以及增强医护人员的文化胜任力为核心要点。
研究结论：术后疼痛管理的阻碍因素与促进因素并非独立存在，而是相互关联的。这一发现提示，需开展针对医护人员、患者及医院管理人员的整体性包容性干预措施。若仅对医护人员开展疼痛生理学、药理学及疼痛管理相关的教育培训，当前的术后疼痛管理现状难以得到改善。还需同步对患者开展相关教育，并改造医院环境，以提供高质量的术后疼痛管理服务。