Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital

Abstract

As urgency accelerates to address the opioid epidemic, there is a pressing need to disseminate non-pharmacological pain management strategies. Complementary and integrative medicine (CIM) therapies show positive clinical benefit with minimal side effects, yet challenges to effective integration in hospital settings remain. While previous qualitative studies have examined the process of integration from the perspective of providers or administrators, there is less understanding of the perspectives of pediatric patients and caregivers regarding integrative pain management. The current study aimed to better understand the process of integration at a large urban pediatric hospital from the perspectives of providers, patients, caregivers, and administrators.

An applied medical ethnography, using participant observation, in-depth interviews, and document review, was conducted at a large urban pediatric hospital in the southern United States from January to July 2017. In the months prior to the study period, an Integrative Medicine Pain Consult Service (IM pilot) was being planned for the spring of 2017. Participant observation was conducted in the outpatient chronic pain clinic, the inpatient pain service, and the IM pilot, and while shadowing the IM pilot providers in their other hospital duties. Informal and formal, recorded interviews were conducted with 34 participants including providers, administrators, patients, and caregivers. Data were managed using Atlas.ti qualitative data management software, and thematic content analysis was conducted.

The employment of evidence in evaluating complementary therapies and the processes involved in integration of complementary therapies were examined. Themes connected to the employment of evidence in evaluating complementary therapies included Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trust Doctors as Experts, and Scientific Evidence Matters to Biomedicine. Themes relating to the process of integration included Collaboration, Pragmatic Issues, Professional Identity, and the Need for a Hospital-Wide Pain Strategy. The current study was the first to incorporate the perspectives of pediatric patients, their caregivers, as well as providers and administrators to create a holistic, in depth understanding of the process of integration in a pediatric hospital setting. Despite limitations, these findings further our understanding of the process of developing integrative medicine programs to treat pediatric pain.