Co-design of developing and integrating model of care for pain management centres: Protocol for a bi-phase Qualitative Study (Preprint)

BACKGROUND Current gold-standard chronic pain management applies a bio-psycho-social lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustained treatment success, increase quality of life, and control symptoms. However, only 40% of chronic pain patients consider themselves to be managed adequately. There is a dearth of evidence-based treatment pathways or Models of Care (MoC) that consistently utilise this holistic approach. OBJECTIVE The aim of this study is to 1) identify the barriers and facilitators to access and engagement in existing MoC for chronic pain, 2) explore aspects of the delivery of care that can be improved, and 3) develop an improved MoC for pain clinics in NSW by directly liaising with people with chronic pain and their families. METHODS A two-phase qualitative study, utilising semi-structured focus groups, will be conducted. Both phases will follow the same structure, such that patients, carers and clinicians will independently provide input into the proposed MoC; which will then be summarised and integrated by the research team. The focus groups in phase one will generate recommendations for primary changes to the existing MoC, these will then be integrated and presented for evaluation to each stakeholder group during phase two. The phase two focus groups will discuss the feasibility and acceptability of the areas for improvement identified. Participants will be encouraged to interact and speak freely across three core domains: 1) experience of chronic pain management, 2) Barriers and Facilitators to delivering/accessing gold standard MoC, and 3) key improvement points to existing models. Each focus group will last 90 minutes and will be audio-recorded and transcribed verbatim for qualitative analysis. RESULTS Data collection was initiated in September 2023 and is expected to end by September 2025. Till February 2024, we have completed the focus group with clinicians (n=12) and patients (n=7) in phase one. Data have not been analysed formally and will be reported in the future publication. CONCLUSIONS The study will explore the perceptions of key stakeholders on the efficiency and outcomes of the current MoC and identify barriers preventing access and the delivery of care. The co-designed MoC can be used to inform appropriate, feasible and acceptable implementation of pain services in the future.