• Kearsley A Stewart, Monika Parshad-Asnani, Ambroise Wonkam, John Bollinger, Valentina Ngo Bitoungui, Edmond Wonkam-Tingang, Jill Powell, Kathia Desronvil, Kathryn R K Benson, Abby Clark, Madelaine Katz, Bianca Martin, Carolyn Peterseim, Christina Williams, Nana Young, Nirmish Shah, Paula Tanabe, Michael Babyak, and Charmaine D M Royal.
• Duke Global Health Institute, Duke University, Durham, North Carolina, USA. Electronic address: k.stewart@duke.edu.
• J Pain Symptom Manage. 2021 Mar 1; 61 (3): 474487474-487.

ContextSickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa.ObjectivesThis cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain.MethodsWe conducted 111 quantitative surveys and 52 semistructured interviews with health-care providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the U.S.ResultsApplying Haywood's scale for assessing SCD provider attitudes, the Jamaica site scored lower on "Negative Attitudes" than the Cameroonian and U.S. sites (P = 0.03 and <0.001, respectively). Providers at the U.S. site scored lower on "Positive Attitudes" than other sites (P < 0.001). "Red Flag" scores at the Cameroon sites were lower than at other sites (P < 0.001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges.ConclusionOverall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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