Are patients' and doctors' accounts of the first specialist consultation for chronic back pain in agreement?

Abstract

IntroductionThe first consultation at a specialist pain clinic is potentially a pivotal event in a patient’s pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors’ messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem.Patients and methodsSixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient–doctor dyads’ understandings of the consultation messages.ResultsPatients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals.DiscussionOverall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did) that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues often generate divergence of understanding or agreement. Despite the widespread recommendations to medical practitioners to check patients’ understanding directly, it does not appear to be routine practice.ConclusionIt is hoped that this research encourages more detailed examination of shared and divergent experiences of pain consultations and also their influence on the subsequent course of intervention and adherence to treatment (not addressed here).

Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis

“…We included 69 studies (figure 1), 24 with clinicians (n=630), 32 with patients (n=1072) 14 44-74 13 with mixed samples of patients and clinicians (n=45) (table 1). [75][76][77][78][79][80][81][82][83][84][85][86][87] Detailed characteristics of included studies can be found in online supplementary table S2. Table 2 shows the results of the critical appraisal of included studies.…”

Exploring patient experiences of a pain management centre: A qualitative study

“…Considering their long relationships with medical clinics and pain management centres, it is quite possible that patients' interactions with the therapeutic team and experiences is represented in how they receive and respond to therapeutic interventions, and that in turn affects treatment outcomes. It is likely that patients' expectations differ from what is offered in clinics [6] although neither party may be aware of this [7]. Establishing a trusting relationship with the healthcare team involved may be an important part of treatment, [8,9] particularly for patient self-management.…”

Do patients with low back pain remember physiotherapists' advice? A mixed‐methods study on patient‐therapist communication

“…This mixed methods study evaluated an aspect of physiotherapist‐patient interaction that previously has not been studied in detail. The initial hypothesis, derived from existing literature (Barker et al, 2009; Darlow et al, 2013, 2015; White et al, 2016) and clinical experience, was that there would be inconsistencies between what the therapist thinks she/he tells the patient and what the patient actually remembers. This hypothesis was not confirmed for the first item of advice that was given (100% concordance); however, for second, and especially for the third item of advice this was more the case (92 and 67% respectively).…”

“…However, this assumption and confidence may be mistaken as the literature shows inconsistencies between physiotherapists' self‐assessment and patients' perception (Miller, 2008; Peek, Carey, Mackenzie, & Sanson‐Fisher, 2018), and problems in communication between patients and physiotherapists and other healthcare professionals (Barker, Reid, & Minns Lowe, 2009; Darlow et al, 2013, 2015; Gulbrandsen, Madsen, Benth, & Laerum, 2010). Patients do not always understand the proposed outcome of the recommended intervention, along with the time frame of the plan of care (White, Lee, & Williams, 2016). Physiotherapists have been found to dominate communication, which has been found to be dependent on the clinician, and only partly individualized to the specific patient (Roberts & Bucksey, 2007; Street, Gordon, Ward, Krupat, & Kravitz, 2005), with the absence of individualized information likely to diminish treatment effectiveness (Lucassen & Olesen, 2016).…”