New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain

Abstract

BackgroundPositive patient expectations are often believed to be associated with greater benefits from complementary and alternative medicine (CAM) treatments. However, clinical studies of CAM treatments for chronic pain have not consistently supported this assumption, possibly because of differences in definitions and measures of expectations. The goal of this qualitative paper is to provide new perspectives on the outcome expectations of patients prior to receiving CAM therapies for chronic low back pain.MethodsWe conducted semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. Interviews were recorded and transcribed. Transcripts were analyzed by a team of experienced qualitative researchers using an immersion/crystallization approach to coding and analysis.ResultsOverall, participants’ expectations of treatment outcomes tended to cluster in four key domains: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment. Furthermore, outcome expectations were complex on several levels. First, the concept of expectations overlapped with several related concepts; in particular, hopes. Participants sometimes used expectations and hopes interchangeably and at other times made clear distinctions between these two terms depending on context. A related finding was that participants were cautious about stating that they expected positive outcomes. Finally, participants articulated strong interrelationships among the four key domains and often discussed how changes in one domain might affect other domains.ConclusionsOverall, these findings contribute to a growing body of literature exploring the role of expectations in patient outcomes. This paper provides important guidance that may help refine the way treatment expectations are studied in the future. In particular, participants’ statements indicate that standardized measures of patient expectations should include items that capture hesitancy to articulate overly optimistic outcomes as well as interrelationships among different outcomes.

Patient expectations for management of chronic non‐cancer pain: A systematic review

“…The qualitative studies (Table ) also showed great discrepancy between the desired and the expected outcome: Patients often expressed a want or a need for pain relief or pain cure but predicted substantial less pain relief or no pain reduction at all …”

“…Furthermore, we found that qualitative findings provided more information about expectations regarding process and structure of care. However, some qualitative studies also restricted themselves to asking focused questions and explored or reported outcome expectations only …”

Development and Validation of the EXPECT Questionnaire: Assessing Patient Expectations of Outcomes of Complementary and Alternative Medicine Treatments for Chronic Pain

“…Questions were drafted to capture hopes and expectations for CAM treatment effects on three domains identified in previous work 9,10 (pain relief, improved function, and improved mood and overall well-being). Questions were drafted about specific domains (sleep, mood) and how much change individuals hoped for and realistically expected in their back pain, and the impact of back pain on their life in one year.…”

“…[9][10][11] Hopes reflect individuals' views of the best-case scenario, whereas expectations are their appraisals of the most likely outcomes, and asking about hope may affect how respondents interpret questions about expectations. [9][10][11] To address these gaps in the literature, a measure of expectations for different CAM treatments for chronic low back pain (CLBP) was developed and evaluated. In recognition of the frequent need in research studies to minimize respondent burden, a short form of this questionnaire was also developed.…”

Complementary medicine and chronic pain management

“…De plus, les patients ont compris la nécessité d'une gestion au long cours de leur pathologie ainsi que des notions comme la qualité de vie, de bien-être. D'autres travaux vont dans ce sens, c'est-à-dire une meilleure acceptation par les patients de leur pathologie chronique, une amélioration des stratégies d'adaptation à leur situation et un renforcement de leur implication dans les soins, dans leur santé, notamment pour l'acupuncture [20][21][22]. De la même façon, si l'hypnose et la méditation, classées dans les approches psychocorporelles des médecines complémentaires, montrent une certaine efficacité sur le symptôme évalué directement par des études, néanmoins de qualité variable et assez hétérogènes [23][24][25][26][27], leurs actions sur les aspects cognitifs et affectifs de la douleur paraissent supérieures [28].…”