Emergency Department staff attitudes towards people presenting in chronic pain: a qualitative study

Objective: Patients who experience their non-malignant chronic pain as intolerable sometimes present at Emergency Departments (EDs). However, since emergency medical services are set up to provide rapid treatment for acute injury or illness; there is potential for misunderstanding and disappointment. Literature on the topic of ED staff attitudes towards chronic pain patients is minimal, USA-based and methodologically unsatisfying. We carried out an in-depth, qualitative study identifying the attitudes and narratives of ED staff around people in chronic pain.

Design: Focus groups with ED staff; qualitative analysis of the group transcripts

Setting: Regional trauma centre in the UK

Subjects: Three focus groups, 20 ED clinicians, mean ED experience 8.1 years

Results: The clinical challenge of treating patients in the ED stemmed from a mismatch between patients’ needs and what the setting can deliver. Participants reported frustration with the system and with chronic pain patients’ perceived inconsistencies and requirements. However, they also highlighted good practice and acknowledged their frustration around not being able to help this group.

Conclusions: ED staff found people presenting at ED with chronic pain to be a challenging and frustrating population to treat. Staff were constrained by the fast-paced nature of their jobs as well as the need to prioritise emergency cases, and so were unable to spend the time needed by chronic pain patients. This was seen as being bad for staff, and for the patient experience. Staff suggested that care could be improved by appropriate information, signposting and with time invested in communication with the patient.