Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument
IntroductionPain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Pain Research |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpain.2024.1254792/full |
| _version_ | 1797300296534196224 |
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| author | Bernadette C. Siaton Bernadette C. Siaton Beth B. Hogans Beth B. Hogans Laura A. Frey-Law Lana M. Brown Christopher M. Herndon Christopher M. Herndon Luis F. Buenaver |
| author_facet | Bernadette C. Siaton Bernadette C. Siaton Beth B. Hogans Beth B. Hogans Laura A. Frey-Law Lana M. Brown Christopher M. Herndon Christopher M. Herndon Luis F. Buenaver |
| author_sort | Bernadette C. Siaton |
| collection | DOAJ |
| description | IntroductionPain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging—Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives.MethodsMixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement.ResultsScoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: “major medical”, i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min.ConclusionThis study, developing and pilot testing our “Pain in Aging—Educational Assessment of Need” (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed. |
| first_indexed | 2024-03-07T23:05:13Z |
| format | Article |
| id | doaj.art-834320c1faab4114a5a0f39dc584857d |
| institution | Directory Open Access Journal |
| issn | 2673-561X |
| language | English |
| last_indexed | 2024-03-07T23:05:13Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pain Research |
| spelling | doaj.art-834320c1faab4114a5a0f39dc584857d2024-02-22T05:19:46ZengFrontiers Media S.A.Frontiers in Pain Research2673-561X2024-02-01510.3389/fpain.2024.12547921254792Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrumentBernadette C. Siaton0Bernadette C. Siaton1Beth B. Hogans2Beth B. Hogans3Laura A. Frey-Law4Lana M. Brown5Christopher M. Herndon6Christopher M. Herndon7Luis F. Buenaver8Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United StatesGeriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United StatesGeriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD, United StatesDepartment of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United StatesDepartment of Physical Therapy and Rehabilitative Science, University of Iowa Carver College of Medicine, Iowa City, IA, United StatesGeriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR, United StatesDepartment of Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL, United StatesDepartment of Family and Community Medicine, St. Louis University School of Medicine, St. Louis, MO, United StatesDepartment of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United StatesIntroductionPain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging—Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives.MethodsMixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement.ResultsScoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: “major medical”, i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min.ConclusionThis study, developing and pilot testing our “Pain in Aging—Educational Assessment of Need” (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed.https://www.frontiersin.org/articles/10.3389/fpain.2024.1254792/fullinterprofessionalinterdisciplinarypain educationclinical decision-makinggeriatricmultimorbidity |
| spellingShingle | Bernadette C. Siaton Bernadette C. Siaton Beth B. Hogans Beth B. Hogans Laura A. Frey-Law Lana M. Brown Christopher M. Herndon Christopher M. Herndon Luis F. Buenaver Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument Frontiers in Pain Research interprofessional interdisciplinary pain education clinical decision-making geriatric multimorbidity |
| title | Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument |
| title_full | Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument |
| title_fullStr | Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument |
| title_full_unstemmed | Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument |
| title_short | Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument |
| title_sort | pain comorbidities and clinical decision making conceptualization development and pilot testing of the pain in aging educational assessment of need instrument |
| topic | interprofessional interdisciplinary pain education clinical decision-making geriatric multimorbidity |
| url | https://www.frontiersin.org/articles/10.3389/fpain.2024.1254792/full |
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