Methods

Study Design

This cross-sectional qualitative study used concept elicitation (CE) interviews and thematic analysis to understand EPs’ approaches to acute pain management, perceived barriers to treatment, and views on patient impacts of inadequately managed pain. CE interviews provide in-depth firsthand insights into participants' experiences, perceptions, and priorities.21,22

Study Sample

The study aimed to recruit 15 US-based EPs to participate in individual, semistructured interviews. Eligible participants were required to be in good clinical standing, hold an active medical license, be certified by the American Board of Emergency Medicine, and be responsible for acute pain management in the ED. Participants were identified and recruited by a qualified third-party vendor (Global Perspectives), using established physician panels and databases, with mutual anonymity between the sponsor and participants. Although the composition of these recruitment sources is not publicly available, participants were recruited from diverse clinical settings, including teaching and nonteaching institutions, public and private hospitals, and a range of geographic settings. Eligible participants were further required to have ≥3 years of experience practicing in an emergency setting following completion of a medical residency/fellowship program, have an average caseload of ≥50% adult patients, and spend an average of ≥6 shifts a month in a clinical emergency setting (excluding shifts in a stand-alone urgent care facility).

Study Procedures

Data collection occurred in March 2024. EPs were recruited using purposive sampling, a nonrandom sampling method, that allowed identification of participants who met the predefined eligibility criteria.23 Each 60-minute interview followed a semistructured interview guide with open-ended questions about EPs’ clinical backgrounds and ED experience, perceived challenges in acute pain management, and perspectives on the patient impacts of inadequately managed pain.

The interview guide was developed with clinical expert input, including an EP, and reviewed by trained qualitative researchers for clarity and alignment with study objectives. Although no formal validation was performed, the development process together with clinical expert input and review of the interview guide supported face validity before use. Interviews were conducted one-on-one using online videoconferencing software. Audio-recordings were transcribed verbatim and coded using both deductive and inductive approaches to address preidentified concepts and capture new concepts that emerged from the data.24 Reporting of study findings adheres to Standards for Reporting Qualitative Research guidelines. Institutional Review Board approval was provided by the WCG Institutional Review Board (study number: 1365464), and study procedures were conducted in accordance with the Helsinki Declaration of the World Medical Association. All interview participants provided verbal consent, and data collection was anonymized to the greatest extent possible.

Analyses

Interview data were evaluated thematically to identify patterns in EP perspectives on acute pain management and the perceived patient impacts of inadequate pain control. All data were coded and analyzed in NVivo (V14) using a consensus-building process in which several team members independently coded the same 3 initial transcripts and compared coding to promote coding consistency. Discrepancies were discussed until consensus was reached.

Concept Saturation

Following coding and analysis, the study team assessed concept saturation, defined as the point at which no new concepts emerged from the data.21,25 Transcripts were ordered chronologically and grouped into 5 sets of 3 interviews, and the first appearance of each concept was assigned to the appropriate set. Nearly all concepts (96%) were identified by the second set of interviews, and all concepts were identified by the fourth set, indicating that concept saturation was reached, and the sample size (n = 15) was sufficient for the study objectives. Therefore, no further participants were recruited.