The COPE Study is an innovative CIHR-funded research program led by Dr. Fiona Webster, Associate Professor in the Arthur and Sonia Labatt Family School of Nursing at Western University. The research focus of COPE is on chronic pain from patient and provider standpoints. Specifically, we use a social science lens through which to view the organization of the care of patients with chronic pain and the “work” that goes into managing chronic pain among patients living with complex social and medical issues. “Work,” in the sense that we are using it, is a key concept of institutional ethnography that refers to what people actually do in particular places, under definite conditions and with definite resources (Smith, 1987, 2005). Through an institutional ethnography approach, we use people’s everyday experiences as the starting point for an exploration of the often invisible social relations that orient experiences. There are two phases to the COPE Study:
COPE I (2015 – 2019)
An institutional ethnography of chronic pain management in family medicine
COPE I explores ethnographically the social organization of primary care for patients with complex chronic pain from the perspectives of primary care providers in Ontario. Findings from this research indicate many patients who suffer from chronic pain also tend to suffer from poverty, poor mental health, and addiction – particularly to opioids. Furthermore, we found significant distance and disjuncture between clinical understandings of medical complexity on the one hand, and the social complexity of patients’ lives on the other. In particular, we found that while primary care clinicians seek to offer the best care, they are often constrained by the parameters of a health care system that assumes patients have resources such as family support, and food and housing security. When physicians did know of their patients’ complex struggles, they lacked the personal and institutional capacity to address them.
COPE II (2019 – 2023)
An institutional ethnography of mental health, addictions and poverty in the lives of people with chronic pain
The natural evolution of our work relates to now explicating and understanding the patient standpoint in relation to chronic pain, which is crucial given the current opioid crisis. Specifically, COPE II focuses on a subset of chronic pain patients that our prior (COPE I) research has identified as the most challenging for primary care providers to effectively treat: patients with low socio-economic status (SES), and thus with few personal resources to mobilize in their struggles with chronic pain. Here, we aim to understand the experiences of patients of low SES with chronic pain to better understand how their “work” is hooked into and organized by the same institutional priorities that organized the experiences of physicians, which we explored in COPE I.
Smith, D. (1987) The everyday world as problematic: A feminist sociology. Boston, MA: Northeastern University Press.
Smith, D. (1995) Institutional ethnography: A sociology for people. Lanham, MD: AltaMira Press.