Factors Influencing the Application of a Biopsychosocial Perspective in Clinical Judgement of Chronic Pain: Interactive Management with Medical Students

Background: Though there is wide support for the application of biopsychosocial perspectives inclinical judgement of chronic pain cases, such perspectives are often overlooked due to either inadequatetraining or attitudes favoring a biomedical approach. Recent research has indicated that despite suchexplanations, both established general practitioners (GP) and medical students account for somepsychosocial factors when making clinical judgements regarding chronic pain cases, but report not beinglikely to apply these in real-world, clinical settings due to numerous factors, including available time withpatients. Thus, it is evident that a greater understanding of clinical judgement-making processes and thefactors that affect application of these processes is required, particularly regarding chronic pain.Objectives: The aims of the current study were to investigate medical students’ conceptualizationsof the factors that influence application of a biopsychosocial approach to clinical judgement-making incases of chronic pain using interactive management (IM), model the relationships among these factors,and make recommendations to chronic pain treatment policy in light of the findings.Study Design: The current study used IM to identify and model factors that influence the applicationof a biopsychosocial approach to clinical judgement-making in cases of chronic pain, based on medicalstudents’ conceptualizations of these factors.Setting: Two university classrooms.Methods: IM is a systems thinking and action mapping strategy used to aid groups in developingoutcomes regarding complex issues, through integrating contributions from individuals with diverseviews, backgrounds, and perspectives. IM commonly utilizes the nominal group technique and interpretivestructural modeling, which in this context were employed to help medical students identify, clarify, andmodel influences on the application of biopsychosocial perspectives in treating chronic pain patients.Results: Results of IM group work revealed 7 core biopsychosocial approach application categories:GP attitudes, cost, GP knowledge, time, patient-doctor relationship, biomedical factors. and patientperception. GP attitudes was the most critical driver of all other competencies in the system, with costand GP knowledge revealed as secondary drivers.Limitations: Potential differences in level of prior biopsychosocial perspective knowledge acrossparticipants and a potentially small sample size (though consistent with past research and appropriate foran exploratory study of this nature – for purposes of achieving the depth and richness of the deliberationand qualitative insights revealed by participants using the IM methodology).Conclusions: Results from this study may be used to both recommend further research on theidentified factors influencing application of biopsychosocial perspectives in treatment of chronic painand support amendment to extant health care policy, particularly with respect to cost, GP attitudes, andknowledge. Though this research claims neither that the influences identified are the only influences onbiopsychosocial application, nor the order of their importance, the research does contribute to an ongoing effort to better understand the factors that influence doctors in their treatment of chronic pain.