Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication

Wiering, Bianca; Boer, Dolf de; Krol, Maarten W.; Wieberneit-Tolman, Hilda; Delnoij, Diana

doi:10.1186/s12913-018-3497-8

Cited by 18 publications

(14 citation statements)

References 46 publications

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“…Clinically, these findings highlight the importance of assessing and addressing treatment expectations at the start of IIPT. Results indicated that higher levels of caregiver expectations, specifically “extremely high” expectations, were associated with more youth pain-related disability and distress at both IIPT admission and discharge, Thus, ensuring that patients and their caregivers adopt realistic expectations of treatment may be especially important for medically complex chronic conditions such as pediatric chronic pain 38. The initial evaluation may be an opportune time for clinicians to provide psychoeducation that adjusts treatment expectations so that they are more reasonable and moderate.…”

Section: Discussionmentioning

confidence: 99%

Will This Treatment Help My Child?

Nelson

Smith

Jervis

et al. 2022

The Clinical Journal of Pain

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Objective: An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. Methods: Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. Results: Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. Conclusion: Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the “need” for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.

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Section: Discussionmentioning

confidence: 99%

Will This Treatment Help My Child?

Nelson

Smith

Jervis

et al. 2022

The Clinical Journal of Pain

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“…The current study extends understanding of the mechanisms through which contextual factors may impact patient health outcomes. Earlier studies have investigated pathways among smaller numbers of contextual variables and suggested, for example, that self-efficacy mediates the impact on osteoarthritis pain of practitioners communicating positive expectancies, 35 affective aspects of the therapeutic relationship may shape Open access patient expectancies in chronic pain, 70 and expectancies might impact pain via reduced catastrophising in chronic back pain. 33 The current results further suggest contextual factors reduce back-related disability in part by enhancing patient self-efficacy for coping with pain, reducing the perceived threat of pain and reducing psychosocial distress.…”

Section: Discussionmentioning

confidence: 99%

Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study

et al. 2021

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ObjectivesContextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches.DesignProspective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months.SettingPhysiotherapy, osteopathy and acupuncture clinics throughout the UK.Participants166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP).Primary and secondary outcomesThe primary outcome was back-related disability. Secondary outcomes were pain and well-being. Contextual components measured were: therapeutic alliance; patient satisfaction with appointment systems, access, facilities; patients’ treatment beliefs including outcome expectancies; practitioners’ attitudes to LBP and practitioners’ patient-specific outcome expectancies. The hypothesised mediators measured were: patient self-efficacy for pain management; patient perceptions of LBP and psychosocial distress.ResultsAfter controlling for baseline and potential confounders, statistically significant predictors of reduced back-related disability were: all three dimensions of stronger therapeutic alliance (goal, task and bond); higher patient satisfaction with appointment systems; reduced patient-perceived treatment credibility and increased practitioner-rated outcome expectancies. Therapeutic alliance over task (ηp2=0.10, 95% CI 0.07 to 0.14) and practitioner-rated outcome expectancies (ηp2=0.08, 95% CI 0.05 to 0.11) demonstrated the largest effect sizes. Patients’ self-efficacy, LBP perceptions and psychosocial distress partially mediated these relationships. There were no interactions with treatment approach.ConclusionsEnhancing contextual components in musculoskeletal healthcare could improve patient outcomes. Interventions should focus on helping practitioners and patients forge effective therapeutic alliances with strong affective bonds and agreement on treatment goals and how to achieve them.

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“…We most probably failed to explain to our patients more explicitly the difference between expectation and desire for pain relief. It seems advisable therefore to be more careful and clearly communicate when asking about patient expectations ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Expectation for Pain Relief on Orofacial Pain Treatment Outcomes

et al. 2021

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Aims: To examine the effects of expectations for pain relief on the objective and subjective outcome of chronic orofacial pain (OFP) treatment.Materials and Methods: Sixty individuals referred to the Orofacial Pain Clinic at the Hebrew University-Hadassah School of Dental Medicine between 2015 and 2017 with OFP reported their expectation for pain relief upon initial consultation. They were also interviewed by telephone after treatment and asked to recall their expectations, referred to as “recalled expectations” (RE). Correlations between RE and treatment success were calculated from pain diaries, and from subjective pain improvement rates (PIR) reported by the patients.Results: 21 males (35.0%) and 39 females (65%), mean age of 46.90 ± 15.77 years and mean pain duration of 49.07 ± 51.95 months participated in the study. All participants rated their expectations as “10” on a 0 to 10 scale during their first visit. RE did not correlate with diary ratings, (P = 0.773) but inversely correlated (−0.3) with PIR (P = 0.020) treatment outcomes.Conclusions: Expectations for pain relief, reported as 10 on a 0–10 scale during the first appointment, may reflect the patient's desire for complete relief of their pain rather than their expectations. Clinicians should therefore be aware of the need for clear communication and wording when examining for expectations. Inverse correlation between recalled expectations and subjective outcome may be due to the nature of recalled expectations when patients already knew their treatment outcomes, and may be explained by the concept of cognitive dissonance.

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Entertaining accurate treatment expectations while suffering from chronic pain: an exploration of treatment expectations and the relationship with patient- provider communication

Cited by 18 publications

References 46 publications

Will This Treatment Help My Child?

Will This Treatment Help My Child?

Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study

The Impact of Expectation for Pain Relief on Orofacial Pain Treatment Outcomes

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