Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach... 2024 Munneke et al

Full title: Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach for healthcare professionals: part of a hybrid effectiveness-implementation study

Abstract

Background
Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain.

Methods
This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders.

Results
The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals’ possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; ‘capability’, ‘opportunity’, and ‘motivation’. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP’s competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice.

Conclusion
We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.

Open access, https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-024-05308-2

 

Textbook example of where a metric becomes a target, it ceases to be useful as a metric. This is in line with another paper posted today, which assumes that psychosocial is good, more psychosocial is better, therefore measuring how much psychosocial clinicians are doing means that they are doing better. But it's all on the assumption that it has to be, like how sticking "Quality product" on some product must mean that it's a quality product, and the more "Quality product" labels you stick on it, clearly the higher the quality of the product.

And there seems to be a sort of move away from assessing whether any of it is effective for patients, decades of failure have proven otherwise, and onto assessing how psychosocial what clinicians are doing is, and grading it based on how much they are applying the things that are assumed to be good.

I think the broader phenomenon really mirrors the MBA approach to management onto health care, where buzzwords dominate everything and plans are substituted for goals, which are assumed to be useful, in part by simply observing that others think the same, and striving to make more of the goal the main goal. So outcomes are irrelevant, all that's really needed is to go full psychosocial, assess how psychosocial people are, and declare that it must be good since it's more psychosocial than when it's less so.

You could pretty much make the same case for political ideologies, where the performance of government departments is based not on how effective they are at fulfilling their goals, but by how dutifully they apply the ideological playbook, simply on the assumption that more of the ideological playbook must be better, since the ideological playbook is good. This study in particular has all the cons of a "design by committee" that is typical of self-serving political ideologies, where everyone's role is merely to try to increase their influence in the system.

I think that part of this appeals for similar reasons that painting-by-numbers does. It gives the illusion of being creative, everyone is 'developing' their own programs, even though they are all mostly identical to one another. They're not doing anything useful, but it feels like it to them. Bit like how the early ready-bake cake mixes did not sell well, until they added the step of adding fresh eggs. Now it's still ready-bake, but it feels like home-baked, at least a bit. It's very ritualistic and egocentric, the patient is basically irrelevant, even as their ideology compels them to pretend that it's what it's all about.

The conclusion is even nothing but "here's what we did", which is not actually a conclusion. It's just a description of what they did, but what they did is to be psychosocial, and being assumed to be good, somehow makes it a conclusion worth writing. Which it isn't.

Honestly they may as well make this about 'power posing', and making the assessment of how effective based simply on how often clinicians adopt a power pose. It's the same thing, there is zero actual difference in overall intent and purpose, certainly not in outcome.