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Barriers and strategies for pain management in non-verbal people with dementia in residential care facilities : protocol for an e-Delphi study
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Introduction: Pain is a prevalent symptom in people living with dementia. Evidence shows that pain frequently remains unrecognised and untreated in this vulnerable population, leading to avoidable suffering. Effective pain management is hindered by multifactorial barriers at the individual, organisational and policy level. This study aims to achieve expert consensus on the key barriers to pain management in non-verbal people living with dementia and strategies to address these barriers within Portuguese residential care facilities.
Methods and analysis: An e-Delphi study will be conducted using two rounds of online questionnaires. The Behaviour Change Wheel (BCW) framework guided the development of e-Delphi statements by linking identified determinants (i.e., barriers and facilitators) to intervention functions. Barriers were extracted from the literature reviews and mapped into the capability, opportunity and motivation–behaviour model. Intervention functions were then selected using the BCW linkage matrices and operationalised into practical strategies. A purposive and snowball sampling approach will be used to recruit a heterogeneous panel of experts across national residential care facilities, including nurses, physicians, managers and policymakers with relevant experience in dementia. During the e-Delphi rounds, participants will be invited to rate the relevance of each barrier and associated strategy(ies) on a five-point Likert scale and provide comments or suggestions. Consensus will be defined as ≥75% agreement on each statement.
Ethics and dissemination: Ethical approval for this study was obtained from the Egas Moniz Ethics Committee (Ref. 1586), and all procedures will comply with the Declaration of Helsinki. Informed consent will be obtained from all participants. The findings will be disseminated through a peer-reviewed publication, scientific events and stakeholder networks, including residential care facilities, to inform future practice and policy in dementia care.
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Félix IB, Ramos C, Guerreiro R, et al. Barriers and strategies for pain management in non-verbal people with dementia in residential care facilities: protocol for an e-Delphi study. BMJ Open 2025;15:e107077. doi: 10.1136/bmjopen-2025-107077
Editora
BMJ