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

Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa. Objectives: This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain Methods: 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) Results: 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 Conclusion: Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional. Abstract source