The experienced barriers and facilitators of healthcare professionals regarding the current use of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-Dutch (PACSLAC-D): a qualitative study

Abstract

Background: Approximately 50% of people with dementia also have a painful condition. Symptoms associated with dementia may lead to difficulties expressing pain experiences. To objectively measure the pain of patients with dementia, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate–Dutch (PACSLAC-D) was developed. Clinical practice shows that the PACSLAC-D is not used effectively in daily practice on the geriatric ward of a general hospital due to improper implementation. To re-implement the PACSLAC-D on the geriatric ward, it is necessary to assess the experienced barriers and facilitators of healthcare professionals (HCPs) regarding the current use of the PACSLAC-D. Aim: To describe HCPs’ experienced barriers and facilitators regarding the current use of the PACSLAC-D on the geriatric ward of a general hospital. Method: A generic descriptive qualitative research design was used, with focus groups and individual interviews. Data analysis was conducted through thematic analysis. Results: Eighteen HCPs participated in the focus groups or interviews. The themes “barriers,” “facilitators,” and “implementation” were identified. The main barrier was nurses’ resistance of use. This resistance can be explained by the nurses’ preference to rely on clinical judgment and the multi-interpretability that nurses experienced. Most important facilitators were the insight that the PACSLAC-D gave into the degree of experienced pain in patients and the course of pain over multiple days. Conclusion: Various barriers and facilitators concerning use of the PACSLAC-D in daily practice were described. The main barrier, nurses’ resistance of use, was explained by nurses’ preference to rely on their clinical judgement and the poor interrater reliability of the PACSLAC-D. To overcome this barrier, HCPs should be engaged in formulating the re-implementation strategy. Recommendations: A tailored re-implementation strategy must be developed in consultation with the HCPs. Future research should evaluate the effects of the re-implementation.