‘Down to the person, the individual patient themselves’: A qualitative study of treatment decision‐making for shoulder pain

Abstract

Introduction: Many inconsistencies have been identified in the translation of evidence-based treatment recommendations for musculoskeletal shoulder pain into healthcare services, with little known about factors influencing decision-making. The objective of this study was to explore the views and experiences of healthcare providers (HCPs) and people living with shoulder pain on treatment decision-making.Methods: Adopting a qualitative design, purposeful sampling was employed to recruit 13 individuals with nonspecific musculoskeletal shoulder pain and 30 HCPs.Data were collected through 1:1 semi-structured interviews and analysed using an approach informed by Constructivist Grounded Theory. To facilitate analysis, two patient and public involvement (PPI) meetings were conducted.Results: Most participants (69%) had shoulder pain of ≥1-year duration. Biomechanical beliefs about shoulder pain predominated and were heavily influential in decision-making for both patients and HCPs. Despite a consensus that therapeutic alliance facilitated decision-making, the extent of collaboration between HCPs and patients in treatment decision-making was rather limited. In addition to conditionspecific factors, Individual patient characteristics and resources also influenced treatment decisions. Conclusion:Findings revealed the complexity of the decision-making process for both patients and HCPs, exposing substantial gaps between the reported views and experiences of participants and the principles of client-centred and evidence-based practice. There is a pressing need to enhance the translation of evidence-based knowledge into practice in this clinical area.

Patients’ and clinicians’ perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme

“…However, this finding may also reflect an importance being placed on establishing a diagnosis and a desire for a diagnostic label, which may suggest biomechanical beliefs about shoulder pain held by patients and some GPs. This aligns with Maxwell et al’s [ 13 ] findings that biomechanical beliefs about shoulder pain held by clinicians and patients with long-term shoulder pain in Ireland, affected decision-making about treatments, imaging and onward referrals.…”

“…There has also been found to be a poor correlation between diagnostic imaging findings, such as USS (Ultrasound Scanning) or MRI (Magnetic Resonance Imaging), and shoulder symptoms [ 11 ]. Despite this evidence, patients in Australia with rotator-cuff related shoulder pain were found to express the view that imaging is necessary for diagnosis of their shoulder pain [ 12 ]; and patients in Ireland with long-term shoulder pain were found to place importance on understanding the biomechanical cause of their pain [ 13 ]. It may therefore follow that uncertainties in relation to prognosis and diagnosis of shoulder pain could lead to patients having unmet expectations.…”

“…Patients’ and clinicians’ views towards treatment decision-making have been explored in patients with long-term pain (the majority with over 1-year pain duration) [ 13 ]. However, the impact that diagnostic and prognostic uncertainties and challenges have on decision-making between primary care clinicians and patients at the level of individual consultations has not been fully explored in the literature.…”

The Function of Osteopathic Medicine in the Treatment of Adhesive Capsulitis

“…She notes that she occasionally requires assistance with overhead activities, such as reaching the top shelf of the kitchen cabinet. Even remarkably so, she was able to return to her previous exercise regime, occasionally participating in stretching and strength exercises to improve her mobility without surgical treatment [ 3 ].…”

‘It feels like my metabolism has shut down’. Negotiating interactional roles and epistemic positions in a primary care consultation

“…9 , 20 Particularly in the final decision‐making phases of consultations, patients typically defer to doctors' expertise regardless of their own level of understanding. 18 , 21 , 22 , 23 Patients who display knowledge in ways that disrupt or resist epistemic asymmetry may be treated as problematic. 24 …”