A mixed-methods investigation into patients' decisions to attend an Emergency Department (ED) for chronic pain.

OBJECTIVE This study explored factors that underpin decisions to seek emergency department (ED) care for chronic non-cancer pain in patients identifying as culturally and linguistically diverse (CALD) or Australian-born. DESIGN AND METHODS A mixed-methods study underpinned by The Behavioural Model of Health Services Use conceptual framework. Consenting consecutive patients attending the ED for a chronic pain condition were recruited to a CALD (n = 45) or Australian-born (n = 45) cohort. Statistical comparisons compared the demographic, pain, health literacy and episode of care profiles of both cohorts. Twenty-three CALD and 16 Australian-born participants consented to an audio-recorded semi-structured interview (n = 24) or focus group (n = 5) conducted in their preferred language. Interviews were translated and transcribed into English for analysis using applied thematic analysis, guided by the conceptual framework. Data were triangulated to investigate the patterns of ED utilisation and contributing factors for both cohorts. RESULTS ED attendance was a product of escalating distress, influenced by the degree to which a participant's perceived need outweighed their capacity to manage their pain. This interaction was amplified by the presence of predisposing factors, including constrained social positions, trauma exposure and biomedical health beliefs. Importantly, experiences varied between the two cohorts with higher degrees of pain catastrophising, lower health literacy and greater social challenges present for the CALD cohort. CONCLUSION This study highlights the role contextual factors play in amplifying pain-related distress for CALD and Australian-born patients with chronic pain. The findings support a need for healthcare providers to recognise features of higher vulnerability and consider streamlining access to available support services.