Balancing Patient-Centered and Safe Pain Care for Nonsurgical Inpatients: Clinical and Managerial Perspectives

摘要

Background: Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patientcentered, meaning that it is respectful of patients’ values, preferences, and experiences. However, little is known about deliveringcare in cases in which these goals may not align. For example, hospitals and clinicians are facing the daunting challengeof balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines andcomplexity of this patient population.Methods: To gather clinical and managerial perspectives on the importance, feasibility, and strategies used to balancepatient-centered care (PCC) and safe pain care for nonsurgical inpatients, the research team conducted in-depth, semistruc-tured interviews with hospitalists, registered nurses, and health care managers from one health care system in the Midwest-ern United States. We systematically examined transcribed interviews and identified major themes using a thematic analysisapproach.Results: Participants acknowledged the importance of balancing PCC and safe pain care. They envisioned this balanceas a continuum, with certain patients for whom it is easier (for example, an opioid-naive patient with a fracture), vs. moredifficult (for example, a patient with opioid use disorder). Participants reported several strategies they use to balance PCCand safe pain care, including offering alternatives to opioids, setting realistic pain goals and expectations, and using a teamapproach.Conclusion: Clinicians and health care managers use various strategies to balance PCC and safe pain care for nonsurgicalpatients. Future studies should examine the effectiveness of these strategies on patient outcomes.