Reducing Stigma of Chronic Pain by Intervention Patient and Provider Co-Design in Dialysis
- Diversity and Equity in Kidney Health - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
- Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Liebschutz, Jane, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Hamm, Megan E., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Bulls, Hailey W., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Olejniczak, Donna, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Eneanya, Nwamaka D., Fresenius Medical Care, Philadelphia, Pennsylvania, United States
- Wilkie, Caroline M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Jhamb, Manisha, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Stigma is frequently experienced by patients with end-stage kidney disease receiving dialysis due to perceptions of health condition etiology or self-care, identity or social context. This is particularly evident for chronic pain, and when considering buprenorphine for therapy.
Semi-structured interviews of patients, multidisciplinary healthcare providers (n=20), dialysis administrators (n=4) and insurers (n=3) informed the conduct and content of three interactive group design sprints with the objective of developing a multilevel intervention to eliminate stigma related to chronic pain care. Group video meeting facilitated sessions occurred twice in one week for two hours and occurred three times with (a) patients only (n=5), (b) providers only (n=5), and (c) both patients, providers and LDO representatives (n=11). Participants prepared by completing assignments and used a whiteboard in meeting to sketch, synthesize and select final strategies.
A total of 27 qualitative interviews identified the lack of owning responsibility for pain management, lack of integration with dialysis and perception that pain was not related to ESKD as a key problems. Buprenorphine expertise is rare, perceived to be of low value and inconvenient to use. Design sprint sessions initially mapped and sketched intervention strategies. Patients promoted strategies to educate both patients and providers. Novel training approaches included modeling of how to evaluate, develop and implement a successful treatment plan. Providers identified organizational strategies employing automation/technology to facilitate care coordination and deliver treatment concurrent to dialysis on site. Incentivization was identified as a requirement for adoption and maintenance. Together a detailed step-by-step plan for how this would occur at the dialysis plan was created as a foundational framework for future testing.
Chronic pain management suffers from lack of ownership by any one discipline for patients receiving dialysis for ESKD. Patients in partnership with providers designing actions to address current gaps have high potential to be feasible and effective to elevate care and eliminate related stigma.
- NIDDK Support