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Service providers' reflections on the affective domain and its influence on decision-making about treatments for chronic pain

School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, Liverpool L69 3GB, UK, cabrown{at}liv.ac.uk

Objectives: This study sought to explore why service providers, working within the complex area of chronic pain, do not believe that the affective domain influences their decision-making about treatments.

Methods: These results were extrapolated from a larger multistage study based on a series of iterative postal questionnaires. Stage 1 of the large study identified, via postal survey, what treatment components service providers identified as `important'. In stage 2, a constructivist framework was used to develop an iterative Delphi questionnaire to explore service providers' rationale for these choices. Stage 3 also employed a Delphi process and asked participants to reflect on their previous comments. Stages 2 and 3 used postal questionnaires and summary reports from preceding rounds for background information.

Results: Most service providers clearly felt that `affect' and `self-image' had little influence on their decision-making compared to `coherence' and `purposiveness'. This report presents the findings of the Stage 3 questionnaire, in which participants were asked to reflect and comment on this low level of endorsement for the influence of affect and self-image. Seven themes emerged from the coded data: professionalism, self-protection, affect and experience, lack of reflective skills, ethos of altruism, lack of understanding, and model of practice. Analysis of these themes indicates a tension between what service providers feel they should do and what they actually do.

Discussion: Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, or preferable, to divorce emotion from the clinical encounter. Chronic illnesses are complex systems that do not respond optimally to linear problem-solving. Access to a wide range of information, including the affective domain, is important for effective decision-making.

Key Words: Affect • Chronic pain • Complexity science • Decision-making

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