Decision-making processes for the self-management of persistent pain: a grounded theory study

This Introduction is advance text extracted from the accepted manuscript. For edited full text in PDF format see:

Clare Fenwick
Senior Lecturer, Course Coordinator, Northern Territory Medical Program, Flinders NT, Charles Darwin University, Darwin NT

Wendy Chaboyer
Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith University, Nerang QLD; Adjunct Professor Patient Safety Centre, Queensland Health, Brisbane QLD

Winsome St John
Research Centre for Clinical and Community Practice Innovations, Griffith University, Gold Coast QLD

PP: 53 - 66


Persistent pain negatively impacts upon the individual suffering this condition. Almost all care related to persistent pain is self-managed. Decision-making is a critical skill of the self-manager and without these skills it would be improbable that effective self-management would emerge. However, current theories regarding decision-making and self-management have not adequately accounted for the many difficulties faced by individuals enduring persistent pain and the consequences of these experiences for the decision-maker. This Grounded Theory study revealed that individuals will transform into three distinct types of decision-makers using three different styles of decision-making in response to the many and varied problems related to the experience of persistent pain. These findings will provide nurses with valuable information to better equip individuals with persistent pain through the decision-making processes necessary for successful self-management.


decision-making, grounded theory, persistent pain, self-identity, self-management, nursing

Article Text

Persistent pain is a leading health problem with up to half of the world's population suffering this condition at some time (Elliott et al., 1999). Persistent pain is known to have a negative physical, psychological, and social impact on people suffering this condition (Gatchel et al., 2007). Individuals with this condition frequently manage their pain condition at home alone (Edworthy, 2000). Decisions regarding the management of their pain are usually made under extraordinary circumstances when the individual is suffering debilitating pain with limited medical support and resources.

The literature informs us that successful self-management of pain depends on individuals having a high level of health literacy (Jordan et al., 2008), a desire to develop collaborative relationships with health professionals involved in their care (National Health Priority Action Council, 2006), and good decision-making capabilities (Kenny, 2004).

However, there is limited research on how individuals go about making those decisions that facilitate the self-management of persistent pain (Eccleston et al., 2007). Furthermore, general theories on decision-making and self-management have not adequately accounted for the many difficulties faced by individuals enduring persistent pain and the consequences of these experiences for the decision-maker. Hence, this grounded theory study was undertaken to 1) explore the meaning decision-making had from the individual's perspective; 2) develop a rich conceptual understanding of the self-management of persistent pain; and 3) understand how this was achieved within a ‘real world' environment.

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