Postoperative Pain Management Among Dominican and American Health-Care Providers: A Qualitative Analysis

Abstract

Purpose: US practitioners have prescribed increasing amounts of opioid analgesics in recent years, contributing to what the Centers for Disease Control (CDC) has declared an opioid epidemic. Opioids are used frequently in the preoperative and postoperative periods for patients undergoing total joint replacement (TJR) in the US and other developed countries, but cross-cultural comparisons of this practice are limited. An international medical mission such as Operation Walk Boston (OpWalk), a humanitarian program that provides TJR surgeries to financially vulnerable patients in the Dominican Republic (DR), offers a unique opportunity to compare postoperative pain management approaches in a developed and developing nation. Methods: We interviewed American and Dominican surgeons and nurses (n = 22 total) during OpWalk 2015. We used a moderator’s guide with open-ended questions to inquire about postoperative pain management and factors influencing prescribing practices. Interviews were recorded and transcripts were analyzed using content analysis. Results: Providers highlighted differences in the patient-provider relationship, pain medication prescribing variability, and access to medications. Dominican surgeons emphasized their adherence to standardized pain protocols and employed a paternalistic model of care, while their American counterparts reported prescribing variability and described shared decision-making with patients. Dominican providers described limited availability of potent opioid preparations in the DR, in contrast to Americans who discussed opioid accessibility in the US. Conclusions: Our findings suggest that cross-cultural comparisons provide useful insight into how opioid prescribing practices, approaches to the patient-provider relationship, and medication access inform distinct pain management strategies in American and Dominican surgical settings. Integrating lessons from cross-cultural pain management studies may yield more effective pain management strategies for surgeries performed in the US and abroad.