title: Temporal horizons in pain management: understanding the perspectives of physicians, physical therapists, and their middle-aged and older adult patients.
abstract: OBJECTIVE
  The management of chronic noncancer pain (CNCP) involves trade-offs between immediate and delayed consequences of various treatments. Temporal trade-offs may be particularly salient for older adults because of age-related differences in prognosis and perceptions of future time. This study examined how perceptions of time influence the management of CNCP among patients and providers with particular emphasis on age differences.
  
  
  METHODS
  Focus groups were conducted with 28 CNCP patients (5 groups), 21 physicians (4 groups), and 23 physical therapists (3 groups). Audiotapes were transcribed and analyzed using standard qualitative methods.
  
  
  RESULTS
  Analyses identified multiple aspects of time perceptions that are relevant to the management of CNCP: the long-term prognosis, the time horizon used for concrete treatment planning, and concerns about future side effects. Although there was some overlap, these aspects showed divergent patterns across age groups and between patients and providers. Patients and providers agreed that pain is more stable and chronic in older adults. Time horizons in treatment planning differed between patients who were present-focused and providers who were focused on longer term effects, but treatment horizons did not differ by patient age. Finally, although providers were more concerned about future side effects in older people, patients' concerns did not differ by age.
  
  
  CONCLUSIONS
  Time horizons have practical implications for the quality of the patient-provider relationship and self-management of CNCP. A better understanding of the underlying mechanisms could inform interventions to reduce age disparities in pain care.
authors.affiliation: Address correspondence to Corinna E. Löckenhoff, Department of Human Ecology, Cornell University, Martha van Rensselaer Hall, Ithaca, NY 14853. E-mail: cel72@cornell.edu.
authors.forename: Corinna E
authors.initials: CE
authors.lastname: Löckenhoff
authors.forename: Seth S
authors.initials: SS
authors.lastname: Laucks
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Port
authors.forename: Judy
authors.initials: J
authors.lastname: Tung
authors.forename: Elaine
authors.initials: E
authors.lastname: Wethington
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D059350:Chronic Pain / Q000523:psychology*; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000523:psychology*; D059825:Physical Therapists; D010820:Physicians; D036301:Qualitative Research; D013997:Time Factors
keywords: Decision making; Focus groups; Pain management; Qualitative research methods; Time and temporal horizons