Development and pilot testing of a sex- and gender-sensitive primary care intervention for patients with chronic non-cancer pain receiving long-term opioid therapy (GESCO): a study protocol

Achim Mortsiefer, Alexandra Schmidt, Alexandra Piotrowski Piotrowski, Klaus Weckbecker, Neele Kufeld, Johannes Just, Susanne Kersten, Birgitt Wiese, Petra Thürmann, Veronika Bencheva, Christine Kersting

Keywords: sex- and gender-sensitive medicine, pain therapy, chronic non-cancer pain, long-term opioid therapy

Background:

In management of chronic non-cancer pain (CNCP) a growing body of evidence suggests that sex and gender aspects influence the experience and expression of pain as well as related emotions. In addition, communication between doctor and patient is influenced by gender stereotypes and dyadic structures. Despite there being evidence on such differences, current guidelines do not consider sex- and gender-sensitive approaches.

Research questions:

The GESCO study aims to develop and pilot test a sex- and gender-sensitive intervention for CNCP patients receiving long-term opioid therapy (LTOT) in primary care.

Method:

The development process follows the first two phases of the UK Medical Research Council Framework for developing and evaluating complex interventions. Phase I will iteratively explore, develop, and evaluate the content and modules of the novel sex- and gender-sensitive intervention using literature reviews, interviews and workshops involving stakeholders and experts. Phase II will pilot-test the novel intervention in a sample of 40 adolescent CNCP patients under LTOT from ten general practices using a single-arm, pre-post design including a qualitative process evaluation focusing on acceptance and feasibility. The intervention will combine in-person educational sessions for GPs and tools supporting patient care.

Results:

In the workshops with GPs and researchers, the following promising elements for intervention have been identified so far: narrative medicine, gender-sensitive communication, gender- and sex-sensitive pharmacotherapy, activation of patients' own resources, social prescribing with provision of tailored psychosocial services.

Conclusions:

This project investigates whether and how the findings from gender-specific medical research can be incorporated into concepts for everyday care. This could provide new ideas not only for the primary care of CNCP patients receiving LTOT, but also for primary care of people with other chronic diseases.

Points for discussion:

From your experience, which specific challenges do you see in primary care management of CNCP patients?

What gender and sex aspects are important in the primary care of these patients?

Which elements could be of particular importance for the intervention?

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