Improving consultations for persistent musculoskeletal low back pain in orthopaedic spine settings: an intervention development

Abstract

Background There is a need to improve consultations between patients with persistent musculoskeletal low back pain and orthopaedic spine clinicians when surgery is not indicated. Poor communication and lack of education about self- management in these consultations have been shown to be associated with increased distress and higher subsequent health care seeking. Aim To develop a standardised intervention to improve spine care consultations for patients for whom surgery is not beneficial. Method The intervention was developed in six stages. The first three stages included: interviews with patients, an interactive workshop with clinicians from a mix of disciplines, and interviews with spine clinicians about their perspective of the recommendations, their perceived difficulties and potential improvements. Information from these stages was synthesised by an expert panel, creating a draft intervention structure and content. The main features of the intervention and the materials developed were then reviewed by patients and spine clinicians. Finally, the research team incorporated the recommended amendments to produce the intervention. Results In total, 36 patients and 79 clinicians contributed to the development of the intervention. The final intervention includes three components: a pre-consultation letter with information suggesting that surgery is one possible intervention amongst many, introducing the staff, and alerting patients to bring with them a potted history of interventions tried previously. The intervention includes short online training sessions to improve clinicians’ communication skills, during the consultation, in reference to listening skills, validation of patients’ pain, and use of appropriate language. Clinicians are also supplied with a list of evidence-based sources for advice and further information to share with patients. Finally, post consultation, a follow up letter includes a short summary of the patients’ clinical journey, the results of their examination and tests, and a reminder of recommendations for self-management. Conclusion The intervention includes aspects around patient education and enhanced clinician skills. It was developed with input from a multitude of stakeholders and is based on patients’ perceptions of what they would find reassuring and empowering when surgery is excluded. The intervention has the potential to improve the patients care journey and might lead to changes in practice in spine clinicians.

“Listen to me, learn from me”: a priority setting partnership for shaping interdisciplinary pain training to strengthen chronic pain care

“…Particular foci for training highlighted by the total number of pain care priorities within categories, included validation of individual's pain experiences (my pain is real, acknowledge me, and my feelings; impact of pain on my whole self; show empathy; trust and believe me; respect my knowledge); safe, effective, and respectful communication; supporting holistic care planned in genuine partnership; supportive self-management tailored to individual's preferences; and acknowledgement of experiences for what worked and did not. Training needs to enhance capabilities in effective pain communication, 32,52 empathic listening and validation, 8,53 and shared decision making, 40 in line with findings from phase 3 showing gaps in EPM content that require strengthening.…”

“…Supporting care aligned to these priorities requires health professionals to take time, to develop reflective practices and understand how to strengthen communication, including how we can better deliver our messages so people want to listen and learn from care teams and partner in cocare planning and enable people with chronic pain to build selfefficacy. 42 Particular foci for training highlighted by the total number of pain care priorities within categories, included validation of individual's pain experiences (my pain is real, acknowledge me, and my feelings; impact of pain on my whole self; show empathy; trust and believe me; respect my knowledge); safe, effective, and 8,53 and shared decision making, 40 in line with findings from phase 3 showing gaps in EPM content that require strengthening. Can these skills be trained?…”

“…While health professionals showed high levels of self-rated confidence in their ability to support care aligned to priorities, evidence indicates challenges to adopting a biopsychosocial framework. 42 , 57 Real-world applications need to extend beyond the “know how” to building practical competencies and capabilities, that is, the “doing.” 16 , 66 , 68 , 69 Novel training interventions show this is possible, 8 , 9 , 26 , 27 , 39 , 41 – 43 , 73 although sustainable implementation remains challenging 31 , 65 with system and service reform critical to bypassing key constraints. 17 , 42 , 57 Target skills are summarised in an elegant recent meta-ethnographic synthesis investigating what it means for a person to live with chronic pain.…”