Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol

Naye, Florian; Légaré, France; Paquette, Jean‐Sébastien; Tousignant-Laflamme, Yannick; LeBlanc, Annie; Gaboury, Isabelle; Poitras, Marie-Ève; April, Karine Toupin; Li, Linda; Hoens, Alison M.; Poirier, Marie-Dominique; Décary, Simon

doi:10.1136/bmjopen-2022-066189

Cited by 3 publications

References 69 publications

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People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey

Naye,

Légaré,

Cachinho

et al. 2024

BMC Prim. Care

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Background Shared decision-making is an imperative in chronic pain care. However, we know little about the decision-making process, especially in primary care where most chronic pain care is provided. We sought to understand decisional needs of people living with chronic pain in Canada. Methods We conducted a population-based cross-sectional online survey of random samples of adults living in Canada with chronic noncancer pain and registered with the Leger Marketing panel. We followed the International Association for Study of Pain definition of chronic pain (i.e., persistent or recurrent pain lasting longer than three months). We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province to achieve representativeness. Based on the Ottawa Decision Support Framework, we collected data on difficult decisions (i.e., decision with more than one option and no clear best option) related to their chronic pain condition, the level of decisional conflict associated with the most difficult decisions (i.e., Decisional Conflict Scale), the assumed and preferred role during the decision-making process (i.e., Control Preferences Scale), and respondents’ characteristics. We used descriptive quantitative analyses of survey responses. Results Of the 31,545 invited panellists, 2,666 met the eligibility criteria, and 1,649 respondents from the 10 Canadian provinces completed the survey. Respondents had diverse socio-demographic profiles. Mean age was 51.8 years (SD = 16.3). Half were men (51.4%), most lived in urban areas (87.8%), mean pain duration was 8.5 years (SD = 9.6), and respondents reported an average number of painful body regions of 2.3 (SD = 1.5). We observed that 96.7% of respondents faced at least one difficult decision across their care pathways. These difficult decisions were related to numerous issues from the medical consultation, diagnosis, treatment, and daily life. Almost half of respondents made their most difficult decision with a primary care physician. One third of respondents experienced a high level of clinically significant decisional conflict (Decisional Conflict Scale score ≥ 37.5). Two-thirds of respondents self-reported having a collaborative role during their decision while three-quarters wanted this role. Conclusions People living with chronic pain in Canada have unmet decisional needs and need support to make optimal decisions to manage their chronic pain. Our findings will guide future development of interventions to implement shared decision-making, especially to support primary care where discussions about difficult decisions often occur. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-024-02667-z.

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People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey

Naye,

Légaré,

Cachinho

et al. 2024

BMC Prim. Care

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People Living with Chronic Pain in Canada Face Difficult Decisions and Decisional Conflict Concerning Their Care: Data from the National DECIDE-PAIN Survey

Naye,

Légaré,

Cachinho

et al. 2023

Preprint

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Background. Shared decision-making is an imperative in chronic pain care. However, we know little about the decision-making process, especially in primary care where most chronic pain care is provided. We sought to understand decisional needs of people living with chronic pain in Canada. Methods. Informed by the Checklist for Reporting Of Survey Studies, we conducted a population-based cross-sectional online survey of random samples of adults living in Canada with chronic noncancer pain and registered with the Leger Marketing panel. We used a stratified proportional random sampling based on the population and chronic pain prevalence of each province to achieve representativeness. Based on the Ottawa Decision Support Framework, we collected data on difficult decisions faced when interacting with health care providers, the level of decisional conflict associated with the most difficult decisions (i.e., Decisional Conflict Scale), the assumed and preferred role during the decision-making process (i.e., Control Preferences Scale), and respondents’ characteristics. We used descriptive quantitative analyses of survey responses. Results. Of the 31,545 invited panellists, 2,666 met the eligibility criteria, and 1,649 respondents from the 10 Canadian provinces completed the survey. Respondents had diverse socio-demographic profiles. Mean age was 51.84 years (SD = 16.33). Half were man (51.36%), most lived in urban areas (87.75%), pain duration ranged from 3 months to 59 years and respondents reported an average number of painful body regions of 2.30 (SD = 1.52). We observed that 96.73% of respondents faced at least one difficult decision across their care pathways. These difficult decisions were related to numerous issues from the medical consultation, diagnosis, treatment, and daily life. Almost half of respondents made their most difficult decision with a primary care physician. One third of respondents experienced a high level of clinically significant decisional conflict (Decisional Conflict Scale score ≥ 37.5). Two-thirds of respondents self-reported having a collaborative role during their decision while three-quarters wanted this role. Conclusions. People living with chronic pain in Canada have unmet decisional needs and need support to make optimal decisions to manage their chronic pain. Our findings will guide future development of interventions to implement shared decision-making, especially to support primary care where discussions about difficult decisions often occur.

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Risk Factors of Decisional Conflict in People Living with Chronic Pain: a pan-Canadian survey.

Naye,

Tousignant-Laflamme,

Sasseville

et al. 2024

Preprint

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Making decisions about chronic pain care is often challenging due to uncertainties, leading to decisional conflict when individuals do not receive the support and information they need. Shared decision-making interventions can help meet these needs; however, their effectiveness is inconsistent in the context of chronic pain. This study aimed to identify the decisional needs influencing decisional conflict among adults with chronic pain in Canada, to guide the development of more comprehensive interventions. In this pan-Canadian online survey, we measured decisional conflict related to the most difficult decision using the Decisional Conflict Scale (≥ 37.5 indicating clinically significant conflict) and assessed decisional needs based on the Ottawa Decision Support Framework. Of the 1,649 participants, 1,373 reported a Decisional Conflict Scale score. The mean age was 52 (SD = 16.4), with half of respondents being men (49.5%) and pain duration ranging from 3 months to 59 years. One-third (33.7%) experienced clinically significant decisional conflict. Seventeen risk factors were identified, including difficulty understanding healthcare information (OR = 2.43) and lack of prior knowledge of available options (OR = 2.03), while role congruence in decision-making was associated with reduced conflict (OR = 0.57). Future SDM interventions could be enhanced by targeting multiple risk factors of decisional conflict.

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Decisional needs assessment for patient-centred pain care in Canada: the DECIDE-PAIN study protocol

Cited by 3 publications

References 69 publications

People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey

People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey

People Living with Chronic Pain in Canada Face Difficult Decisions and Decisional Conflict Concerning Their Care: Data from the National DECIDE-PAIN Survey

Risk Factors of Decisional Conflict in People Living with Chronic Pain: a pan-Canadian survey.

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