What Are Orthopaedic Healthcare Professionals’ Attitudes Toward Addressing Patient Psychosocial Factors? A Mixed-Methods Investigation

Abstract

Background Integrating psychosocial resources into orthopaedic clinics can reduce psychological distress and opioid use after injury, enhance functional outcomes, and increase patient satisfaction with care. Establishing referral pathways for connecting orthopaedic patients with psychosocial resources requires the active collaboration and buy-in of orthopaedic healthcare professionals. Designing and disseminating psychosocial training materials for orthopaedic healthcare professionals requires a nuanced understanding of orthopaedic healthcare professionals' current attitudes toward addressing psychosocial factors, including any stigma and misconceptions about mental health that exist.This work was funded by a grant from the National Center for Complementary and Integrative Health awarded to Dr. Ana-Maria Vranceanu (1U01AT010462-01A1). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was obtained from Mass General Brigham (number 2020P000095).

CORR Insights®: Surgeons Receiving Information About Patient Language Reflecting Unhelpful Thoughts or Distress About Their Symptoms Identify Such Language More Often Than Those Who Do Not Receive This Information

“…Additionally, what actions result from increased identification of unhelpful thoughts or distress? A study of orthopaedic clinicians highlighted challenges in addressing psychosocial factors, including perceived lack of resources [9]. The present study [3] focused on volume versus accuracy of detection, given that there is no ideal way to evaluate accuracy and because there is a lack of harm in overidentification.…”

Trauma System Support to Facilitate Recovery

“…Barriers also exist in that medical education and modern trauma algorithms have not yet embraced these services, resulting in physicians, nurses, and other providers ill-equipped to identify and treat conditions outside of their traditional spheres. 51 Furthermore, most providers are already overextended, so that "I have no time for this," is a common defense. Over time, health care providers are slowly becoming more educated about the processes and benefits of screening for mental illness and deficient SDOH, and they understand the value in having services in proximity to refer patients for resources and care.…”

Improvements in Physical Function and Pain Interference and Changes in Mental Health Among Patients Seeking Musculoskeletal Care

“…24,28 Musculoskeletal clinicians also have discrepant opinions regarding whether addressing patients' mental health falls within their professional role. 24,28,29 Some musculoskeletal clinicians are interested in additional resources to better address mental health within the musculoskeletal care setting, 30 but acquisition of these resources has remained challenging without widespread agreement regarding the need for this investment. 28,29,31 A better understanding of the associations between physical health and mental health changes can guide musculoskeletal clinicians in: (1) the importance they place on addressing mental health-related symptoms as a component of their patient care, and (2) how they counsel patients regarding expectations of their symptom trajectory as their physical impairment is addressed.…”