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scientific articles

“Pain Is Subjective”: A Mixed-Method Study of Provider Attitudes and Practices Regarding Pain Management in Sickle Cell Disease Across Three Countries

key information

source: Journal of Pain and Symptom Management

year: 2020

authors: Kearsley A.Stewart, Monika Parshad-Asnani, Ambroise Wonkam, John Bollinger, Valentina Ngo Bitoungui, Edmond Wonkam Tingang, Jill Powell, Kathia Desronvil, Kathryn Benson, Abby Clark, Madelaine Katz, Bianca Martin, Carolyn Peterseim, Christina Williams Nana Young, Nirmish Shah, Michael Babyak, Paula Tanabe, Charmaine DM.Royal


Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa.

This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain

We conducted 111 quantitative surveys and 52 semi-structured interviews with healthcare providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the United States (US)

Applying Haywood’s scale for assessing SCD provider attitudes, the Jamaica site scored lower on ‘Negative Attitudes’ than the Cameroonian and US sites (p =.03 and < .001, respectively). Providers at the US site scored lower on ‘Positive Attitudes’ than other sites (p <. 001). ‘Red Flag’ scores at the Cameroon sites were lower than at other sites (p < .001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges

Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.

organization: Duke University, United States; University of the West Indies, Jamaica; University of Cape Town, South Africa; University of North Carolina, United States; University of Dschang, Africa; Harvard University, United States; Medical University of South Carolina, United States; Center for Applied Ethics, United States

DOI: 10.1016/j.jpainsymman.2020.08.029

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