Activating waitlists: Identifying barriers and facilitators to pain self-management while waiting

Area of Science:

• Pain Management
• Qualitative Research
• Health Psychology

Background:

• Extensive waitlists for pain management services risk patient decline and treatment disengagement.
• Currently, passive waiting is the norm, with no standardized interventions for those awaiting outpatient pain management.
• Understanding barriers and facilitators to self-management during the wait is crucial for intervention development.

Purpose of the Study:

• To identify barriers and facilitators to pain self-management in individuals awaiting chronic pain management services.
• To lay the groundwork for developing a prehabilitation intervention for patients on pain management waitlists.
• To explore patient experiences of waiting and their impact on self-management capacity.

Main Methods:

• An inductive qualitative approach was employed.
• Semi-structured interviews were conducted with 38 individuals on pain management waitlists.
• Data analysis utilized reflexive thematic analysis, informed by the Theoretical Domains Framework and COM-B model.

Main Results:

• Four key barriers were identified: systemic navigation issues ('Shunted Around the System'), lack of information ('The Information Gap'), difficulty adapting ('Resisting Adaptation'), and diminished hope ('Losing Hope').
• One significant facilitator emerged: proactive self-management ('Help Yourself or Lose Yourself').
• The waiting period significantly impacts emotional well-being and motivation, potentially leading to treatment disengagement.

Conclusions:

• The waitlist period presents a critical opportunity for prehabilitation to support patient well-being and self-management engagement.
• Addressing infrastructural and interpersonal barriers, such as poor communication and pain invalidation, is essential for improving motivation.
• Enhancing self-efficacy, pain acceptance, self-compassion, and internal locus of health control are vital for improving pain self-management within a prehabilitation framework.