Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study

Maxwell, Krista; Streetly, Allison; Bevan, David

doi:10.1136/bmj.318.7198.1585

Cited by 146 publications

(142 citation statements)

References 21 publications

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“…Patients with SCD may experience problematic interpersonal experiences in the healthcare setting. 8,9 In previous work, we have shown that hospitalized SCD patients are more likely than other hospitalized patients to report poor interpersonal experiences of care. 10 Negative healthcare provider attitudes serve as a barrier to the delivery of appropriate pain management among these patients, and poor communication with healthcare providers is associated with lower trust and problematic clinical outcomes, such as discharge against medical advice.…”

Section: Introductionmentioning

confidence: 93%

Perceived Discrimination, Patient Trust, and Adherence to Medical Recommendations Among Persons with Sickle Cell Disease

Lanzkron²,

et al. 2014

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Section: Introductionmentioning

confidence: 93%

Perceived Discrimination, Patient Trust, and Adherence to Medical Recommendations Among Persons with Sickle Cell Disease

Lanzkron²,

et al. 2014

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“…Providing care to patients with frequent ED visits can contribute to frustration levels experienced by both patients and ED staff. [10][11][12][13] It is a common perception of emergency physicians and staff that SCD patients presenting to the ED are opioid dependent, and this belief may lead to inconsistent or inadequate treatment. 14,15 Both physicians and nurses tend to overestimate the prevalence of addiction in the SCD population, which has been documented to range from 0% to 11%.…”

Section: Discussionmentioning

confidence: 99%

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Tanabe

Artz

Courtney

et al. 2010

Academic Emergency Medicine

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Objectives: The objectives were to report the baseline (prior to quality improvement interventions) patient and visit characteristics and analgesic management practices for each site participating in an emergency department (ED) sickle cell learning collaborative.Methods: A prospective, multisite longitudinal cohort study in the context of a learning-collaborative model was performed in three midwestern EDs. Each site formed a multidisciplinary team charged with improving analgesic management for patients with sickle cell disease (SCD). Each team developed a nurse-initiated analgesic protocol for SCD patients (implemented after a baseline data collection period of 3.5 months at one site and 10 months at the other two sites). All sites prospectively enrolled adults with an acute pain crisis and SCD. All medical records for patients meeting study criteria were reviewed. Demographic, health services, and analgesic management data were abstracted, including ED visit frequency data, ED disposition, arrival and discharge pain score, and name and route of initial analgesic administered. Ten interviews per quarter per site were conducted with patients within 14 days of their ED discharge, and subjects were queried about the highest level of pain acceptable at discharge. The primary outcome variable was the time to initial analgesic administration. Variable data were described as means and standard deviations (SDs) or medians and interquartile ranges (IQR) for nonnormal data.Results: A total of 155 patients met study criteria (median age = 32 years, IQR = 24-40 years) with a total of 701 ED visits. Eighty-six interviews were conducted. Most patients (71.6%) had between one and three visits to the ED during the study period. However, after removing Site 3 from the analysis because of the short data enrollment period (3.5 months), which influenced the mean number of visits for the entire cohort, 52% of patients had between one and three ED visits over 10 months, 21% had four to nine visits, and 27% had between 10 and 67 visits. Fifty-nine percent of patients were discharged home. The median time to initial analgesic for the cohort was 74 minutes . Differences between choice of analgesic agent and route selected were evident between sites. For the cohort, 680 initial analgesic doses were given (morphine sulfate, 42%; hydromorphone, 46%; meperidine, 4%; morphine sulfate and ibuprofen or ketorolac, 7%) using the following routes: oral (2%), intravenous (67%), subcutaneous (3%), and intramuscular (28%). Patients reported a significantly lower targeted discharge pain score (mean ± SD = 4.19 ± 1.18) compared to the actual documented discharge pain score within 45 minutes of discharge (mean ± SD = 5.77 ± 2.45; mean difference = 1.58, 95% confidence interval = .723 to 2.44, n = 43).

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“…Control may have a positive influence on these factors [22]. This factor may be particularly important for patients with SCD and may be a possible explanation for the fact that no difference in pain or quality of life was found between the CIgroup and PCA-group despite the large difference in the amount of morphine used [23,24]. Furthermore, patients in the PCA-group appeared to accept a pain score of 5.5 and did not titrate to achieve a pain-free state, while most health professionals titrate pain medication to reduce even mild pain.…”

Section: Side Effects and Adverse Eventsmentioning

confidence: 99%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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Intravenous morphine is the treatment of choice for severe pain during vaso‐ occlusive crisis in sickle cell disease (SCD). However, side effects of morphine may hamper effective treatment, and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient's reported pain. Patient‐controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. In this randomized controlled study, the efficacy of intravenous morphine administration with PCA was compared with continuous infusion (CI) of morphine in patients with SCD during vaso‐occlusive crisis. Twenty five consecutive episodes of vaso‐occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA‐group had a markedly and significant lower mean and cumulative morphine consumption when compared with the patients in the CI‐group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative morphine consumption in the PCA‐group led to significant less nausea and constipation during treatment when compared with the CI‐group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA‐group. PCA results in adequate pain relief at a much lower morphine consumption and should considered to be the first choice in morphine administration to sickle cell patients admitted with vaso‐occlusive crisis. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study

Cited by 146 publications

References 21 publications

Perceived Discrimination, Patient Trust, and Adherence to Medical Recommendations Among Persons with Sickle Cell Disease

Perceived Discrimination, Patient Trust, and Adherence to Medical Recommendations Among Persons with Sickle Cell Disease

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

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