Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analysis of Primary Care Providers? Experiences and Attitudes

Abstract

Objectives: Most patients with chronic non-cancer pain (CNCP) are cared for, by primary care providers (PCPs). While some of the barriers faced by PCPs have been described, there is little information about PCPs’ experience with factors that facilitate CNCP care. Design: The study design was descriptive and qualitative. Data were analyzed using qualitative content analysis. Krippendorff’s thematic clustering technique was used to identify the repetitive themes regarding PCPs’ experiences related to CNCP management. Subjects: Respondents were PCPs (n=45) in the VA Connecticut Healthcare System in two academically affiliated institutions and six community based sites. Results: Eleven themes were identified across systems, personal/professional, and interpersonal domains. Barriers included inadequate training, organizational impediments, clinical quandaries and the frustrations that accompany them, issues related to share care among PCPs and specialists, antagonistic aspects of provider-patient interactions, skepticism, and time factors. Facilitators included the intellectual satisfaction of solving difficult diagnostic and management problems, the ability to develop keener communication skills, the rewards of healing and building therapeutic alliances with patients, universal protocols, and the availability of complementary and alternative medicine resources and multidisciplinary care. Conclusion: PCPs experience substantial difficulties in caring for patients with pain while acknowledging certain positive aspects. There is a need for strategies that mitigate the barriers to pain management while bolstering the positive aspects to improve care and provider satisfaction.