We aimed to undertake a QES using the methods of meta-ethnography reported by Toye and colleagues8 to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain and thus to inform improvements in the experience and quality of health care. Patients report dissatisfaction with their HCP interaction13 and the relationship between patients and HCPs can have a significant effect on health outcomes. Already we know that, from the patient perspective, the experience of health care can be adversarial.8 It seems likely that HCPs’ responses can have an impact on quality of care. Thus, understanding the experience of providing health care to people with chronic non-malignant pain from the perspective of the HCP can have important implications for delivery of health care, decision-making and health-care quality.
Our findings can help us to consider the experience of health care from both perspectives and understand tensions that may contribute to this adversarial experience. Specifically:
- The findings indicate an underlying scepticism that might contribute to an adversarial relationship between HCP and patient. Believing patients’ experiences may provide a more secure foundation for an effective therapeutic relationship.
- The findings indicate a dualistic approach whereby HCPs make a sudden shift from biomedical to biopsychosocial explanations for pain after exhausting attempts to decipher a diagnosis. This abrupt shift may exacerbate a sense of loss of credibility for patients.
- The findings indicate that some HCPs engage in judgements about what is real or not real, which are underpinned by a cultural duality of real (biomedical) and not real (psychosocial).
- The findings suggest that an embodied, rather than dualistic, biopsychosocial model that focuses on the personal meaning of pain from the outset might help to lessen the adversarial experience and also reduce the HCP’s sense of failure.
- The findings have clinical and educational implications. How can we enable HCPs to manage the tensions that underpin the experience of providing health care to people with chronic non-malignant pain? How do we recognise and support the complexity of skills and emotional cost of providing health care to people with chronic non-malignant pain?
- The findings highlight the benefits of reciprocity, mutuality and collaboration between HCPs and the benefits of being able to break down or cross professional boundaries and hierarchies.
- The findings highlight a need to consider the emotional costs to HCPs of treating patients with chronic pain.
We invite HCPs to use our ‘mixing console’ to help them to think about their encounters with patients. This console may be transferable to other chronic conditions.