title: What are the Decision-making Processes that Underpin the Self-management of Persistent Pain?
Creators: name: Fenwick, Clare Elizabeth
Publisher: name: Griffith University
Year: 2008
Subjects: subject: persistent pain management
subject: chronic disease prevention
subject: decision-making
subject: self-management of persistent pain
subject: health professionals

description: This study explored the decision-making processes that underpinned the self-management of persistent pain, and was inspired by the increasing interest in chronic disease prevention and the 2005 Australian Government’s, ‘National Chronic Disease Strategy’. A grounded theory methodology with symbolic interactionism underpinnings facilitated the intent of this study: to explore the meaning decision-making had from the individual’s perspective; to develop a rich conceptual understanding of the self-management of persistent pain; and to understand how this was achieved within a ‘real world’ environment. Purposeful and theoretical samplings were used to recruit 13 participants from two different Queensland pain clinics. Most of the participants were middle-aged, unemployed women, and many had experienced neuropathic pain for at least 15 years. Data collection was predominately via in-depth interviews conducted mostly in the participant’s home environment. Further data was sourced from current and past literature, experts in the area of study, and observations. Data analysis used grounded theory specific strategies including theoretical sensitivity; comparative analysis; open, axial, and selective coding processes; memoing; the paradigm; and the condition/consequential matrix. Conceptualizations of the findings revealed that individuals transform into three distinct types of decision-makers, and undertake three styles of decision-making, in response to the many and varied problems related to the distressing experience of persistent pain and multiple losses. The experiences of persistent pain and sustaining multiple losses collectively caused disruption to the known self. Emerging from the disruption of the self were three distinct self-identities, the degenerating self, disconnecting self, and preserving self. Each self-identity was confronted by particular problems relevant to each distinct identity. In response to these diverse problems, three different decision-making styles became known; the impulsive, bargaining, and judicious decision-making styles. Each style of decision-making was defined and supported by a certain type of decision-maker, the susceptible, adaptive, and expert decision-maker. It was the collective processes of making decisions about the disruptive and life-changing experiences of persistent pain and multiple losses that precipitated the transformation of the deciding self. It was this transforming process that the individual redefined, situated, and distinguished the self from others, thus characterising the self as the decider and self-manager of pain. In summary, the findings in this study have implications for the education and future practices of health professionals who assist in the management of persistent pain. These findings have also provided new information that will enhance the decision-making approaches undertaken by individuals who self-manage persistent pain.