Unleashing the Potential of Primary Care Nurses in Chronic Pain Management: A Delphi Study on Priority Activities

Context: Chronic pain stands as a leading cause of disability globally, with patients often reporting inadequate access to primary care. Relevant primary care nursing activities for CP management remain poorly defined, limiting the full utilization of nurses' competencies and expertise in chronic disease management.

Objective: To identify and prioritize nursing activities for chronic pain management in primary care by adopting nurse and patient perspectives.

Study Design, Setting, and Participants: We conducted a three-round Delphi study with nurses from primary care practices and patients living with pain for more than three months across Québec, Canada. This study was conducted in partnership with two patient partners living with chronic pain.

Instrument and Outcome Measures: The research utilized web-based questionnaires within REDCap^®. In the initial round, panellists identified nursing activities for chronic pain management they deemed most important through open-ended questions. In the two subsequent rounds, nursing activities were (items) were assessed for their importance using a 9-point Likert scale. Activities achieving agreement (≥75% of participants rating the importance at 7, 8, or 9, i.e., priority activities) composed the list from rounds 2 to 3 and the final list. Mean scores (and standard deviations) were also calculated for each activity to rank their importance.

Results: 48 nurses and 122 patients participated (n=170) throughout the process. From 47 nursing activities derived from 1167 suggestions in the first round, 41 were prioritized by ≥75% of participants by the final round. These activities were grouped into four domains: global assessment (n = 15, 36.6% of all activities), care management (n = 10, 24.4%), health promotion (n = 7, 17.1%), and interprofessional collaboration (n = 9, 22.0%). The top three nursing activities based on the final mean score were: Assessing dimensions of pain experience, Screening signs and symptoms of mood disorders, and Establish a therapeutic alliance with empathic approach.

Conclusions: Nurses and patients identified a shared set of nursing activities for primary chronic pain care that aligns with usual care already provided by nurses to patients living with chronic diseases. Our results will guide primary care practices and nurses’ activities to improve chronic pain management.