Introduction
The article “A systematic review of barriers and interventions to improve appropriate use of therapies for Sickle Cell Disease” by Haywood et al. (2009) stemmed from the gap between the availability of effective pain management therapies and underutilization of these therapies. There have been great advances in medicine for SCD and some areas in the US have shown a remarkable improvement in the life expectancy for individuals with SCD. On another note, however, high mortality rates are still reported in the same country.
The problem is inevitably due to the nurses because they are charged with the responsibility of administering treatment and monitoring patients’ progress. This study was a review of barriers and interventions that influence the use of pain management therapies. Based on this review, it was concluded that effective management of pain can be achieved if associated barriers were addressed. These barriers include negative attitudes by the healthcare provider and inadequate knowledge on how to manage pain in SCD.
This review was able to address the initial research question “How can nurses effectively manage and assess the pain and crisis associated with sickle cell disease?” by creating solutions that would help nurses in their daily practice. The nurse has a crucial role to play in the active management of pain in SCD if the right attitude and demeanor are portrayed to the patients.
Statistical Tests
This review did not use any formal statistical test due to variation in study populations, research designs, and outcomes being measured. However, complex data was categorized to suitable themes relevant to the study while interventions and outcomes were classified appropriately (Haywood et al., 2009, p. 1023-4).
The study was a review of previous articles; thus, analysis of data focused on the quality of the studies reviewed. The quality of randomized studies was determined using a scoring system by Jadad et al. (1996). The quality of other types of studies was determined using a checklist that listed key elements that define a credible research study.
Also, a grading system obtained from Atkins et al. (2004) was used to grade evidence by examining the risk of bias in the reviewed studies, the ability of the study to answer the research questions, and the precision, validity, and reliability of findings. Two reviewers with clinical and methodological expertise evaluated the quality of studies and evidence.
Formulation of Conclusion
Evidence was separately reviewed. A conclusion on the evidence on existing barriers and interventions was based on the quantity of evidence as per the number of studies that indicated a certain factor as a barrier, facilitator, or neither. High evidence was based on >10 studies, moderate evidence was governed by 6-10 studies, low evidence was based on 3-5 studies while insufficient evidence was denoted by 0-2 studies.
This quantity grade was then reduced by one level in case a study indicated some bias by failing to control possible confounding factors in the case of cross-sectional studies, or if a qualitative study failed to report on the opinions of both patients and providers. The score was further reduced by 1 level and 2 levels, respectively, if 75% and 50% of the studies evaluating a factor identified it as a barrier, facilitator, or having no association with the treatment given. On the other hand, scores were raised by 1 level if 100% of the studies gave similar results about a particular factor under investigation.
Future Research
This review was not exhaustive regarding the research question. Most of the reviewed studies focused on children; hence, more research is needed on barriers to effective pain management in SCD among adults. In addition, more intervention studies focusing on direct outcomes, for example, reduced pain score, and those focusing on interventions that were not reviewed in this study, such as hydroxyurea, should be conducted.
References
Atkins, D., Best, D., Briss, P. A., Eccles, M., Falck-Ytter, Y., Flottorp, S., …Zaza, S. (2004). Grading quality of evidence and strength of recommendations. BMJ, 328(7454), 1490.
Haywood, C., Beach, C., Lanzkron, S., Strouse, J., Wilson, R., Park, H., …Segal, J. (2009). A Systematic Review of Barriers and Interventions to Improve Appropriate Use of Therapies for Sickle Cell Disease. J Natl Med Assoc., 101, 1022-1033.
Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. j., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 17(1), 1-12.