Multidimensional Experience of Pain in Adults with Advanced Liver Disease

BackgroundUnrelieved pain is a significant problem for adult patients living with advanced liver disease such as cirrhosis. Poorly managed pain can reduce the quality of living and dying among this growing population. The lack of research exploring the physical, psychological, and sociocultural dimensions of pain may contribute to insufficient pain appraisal and missed opportunities for treatment. Exploring the patient’s experience with pain, the implications of advanced liver disease severity on pain, and self-care pain management strategies will be instrumental in developing future interventional studies. Purpose The overall aim of this thesis is to examine pain from a multidimensional perspective for patients with advanced liver disease. Design A convergent parallel mixed methods design, comprised of a survey study and a semi-structured interview study, was conducted in a Toronto hepatology clinic between May and September 2021. Methods Following a scoping review study, a cross-sectional survey study was conducted for adult patients with advanced liver disease using convenience sampling. The Brief Pain Inventory (Short Form) was used to collect data on pain characteristics, self-care management, and pain interference data. The qualitative descriptive study of semi-structured interviews was conducted concurrently. Through convenience sampling, participants who completed the Brief Pain Inventory (Short Form) were invited to participate in the semi-structured interviews. The results from the survey and interview studies were integrated using a joint display table that aligned quantitative and qualitative findings according to the research questions. Comparison and synthesis was performed to identify data patterns of convergence or divergence. Findings The design of our cross-sectional and qualitative descriptive studies was shaped by a multidimensional framework that centered on the patient’s pain experience. In our cross-sectional survey of 118 participants, we found that the severity of liver disease was associated with pain intensity and pain interfered with general activity, walking, sleep, and normal work. Participants reported using acetaminophen as the primary pain management strategy. In the qualitative descriptive study, which included 15 participants, we found that pain is multidimensional, and pain interfered with the physical, psychological, and sociocultural domains of a person’s life. The participants described partial relief when using acetaminophen. We found mostly convergence in this mixed methods study where data from the cross-sectional survey study was congruent with the information from the qualitative descriptive study. Conclusion This thesis highlighted how common pain is for patients with advanced liver disease and the multidimensional nature of their pain. Despite the high prevalence and complexity of pain among these patients, effective pain relief remains a challenge for the majority. Understanding the pain experience of adult patients with advanced liver disease using multidimensional pain appraisal tools can inform the effective use of comprehensive pain management strategies to address the interconnected physical, psychological, and sociocultural dimensions of pain.

Department dc:contributor.department

Nursing Science

Year dc:date.issued

2024

Author dc:creator

• Gorospe, Franklin

Advisors dc:contributor.advisor

• Dale, Craig
• Puts, Martine

• Liver Disease
• Multidimension
• Nursing
• Pain

Statement dc:rights

• Attribution-NonCommercial-NoDerivatives 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nc-nd/4.0/

Handle dc:identifier.uri

http://hdl.handle.net/1807/141055

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/141055