Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations
Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations
Objective This study aimed to explore the perceptions of orthopaedic clinicians about consultations for people with persistent musculoskeletal low back pain (PMLBP) in which surgery is not recommended. Surgery is not recommended for the majority of PMLBP consulting in secondary care settings. Setting Secondary care sector in the UK. Participants Semi-structured qualitative interviews were conducted with 24 orthopaedic team clinicians from 17 different hospitals in the UK and Ireland. Interviews explored clinicians' perceptions of the challenges in consultations where surgery is not indicated. Interviews were transcribed verbatim and analysed using thematic analysis. Results Two meta-themes, Difficulties and Enablers, each consisting of several subthemes were identified. Difficulties included challenges around the choice of appropriate terminology and labels for PMLBP, managing patients' expectations, working with mentally vulnerable patients and explaining imaging findings. Enablers included early management of expectations, use of routine imaging, triaging, access to direct referral elsewhere, including other non-surgical practitioners in the team, training to improve communication skills and understanding of psychological issues. Conclusion The findings highlight clinicians' perceived need for concordance in messages delivered across the care pathway and training of orthopaedic clinicians to deliver effective reassurance and address patients' needs in circumstances where surgery is not indicated.
back pain, orthopaedic & trauma surgery, surgery
Braeuninger-weimer, Kathrin Louise
68e2ec85-e120-4819-a83b-5960d6c8492d
Anjarwalla, Naffis
acf45c42-ee96-491c-9225-1fec6090a0db
Mcgregor, Alison H
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Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
Sell, Philip
c2650a9b-5044-4b6d-8b0f-a7f5a557666d
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
16 September 2021
Braeuninger-weimer, Kathrin Louise
68e2ec85-e120-4819-a83b-5960d6c8492d
Anjarwalla, Naffis
acf45c42-ee96-491c-9225-1fec6090a0db
Mcgregor, Alison H
7fe03a9a-c87f-4eb2-889c-3d08d330177f
Roberts, Lisa
0a937943-5246-4877-bd6b-4dcd172b5cd0
Sell, Philip
c2650a9b-5044-4b6d-8b0f-a7f5a557666d
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Braeuninger-weimer, Kathrin Louise, Anjarwalla, Naffis, Mcgregor, Alison H, Roberts, Lisa, Sell, Philip and Pincus, Tamar
(2021)
Taking patients to the ice cream shop but telling them that they cannot have ice cream: a qualitative study of orthopaedic spine clinicians’ perceptions of persistent low back pain consultations.
BMJ Open, 11 (9), [e052938].
(doi:10.1136/bmjopen-2021-052938).
Abstract
Objective This study aimed to explore the perceptions of orthopaedic clinicians about consultations for people with persistent musculoskeletal low back pain (PMLBP) in which surgery is not recommended. Surgery is not recommended for the majority of PMLBP consulting in secondary care settings. Setting Secondary care sector in the UK. Participants Semi-structured qualitative interviews were conducted with 24 orthopaedic team clinicians from 17 different hospitals in the UK and Ireland. Interviews explored clinicians' perceptions of the challenges in consultations where surgery is not indicated. Interviews were transcribed verbatim and analysed using thematic analysis. Results Two meta-themes, Difficulties and Enablers, each consisting of several subthemes were identified. Difficulties included challenges around the choice of appropriate terminology and labels for PMLBP, managing patients' expectations, working with mentally vulnerable patients and explaining imaging findings. Enablers included early management of expectations, use of routine imaging, triaging, access to direct referral elsewhere, including other non-surgical practitioners in the team, training to improve communication skills and understanding of psychological issues. Conclusion The findings highlight clinicians' perceived need for concordance in messages delivered across the care pathway and training of orthopaedic clinicians to deliver effective reassurance and address patients' needs in circumstances where surgery is not indicated.
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Taking patients to the ice cream shop but telling them they cannot have ice cream (2021)
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Accepted/In Press date: 2 September 2021
e-pub ahead of print date: 16 September 2021
Published date: 16 September 2021
Additional Information:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
back pain, orthopaedic & trauma surgery, surgery
Identifiers
Local EPrints ID: 453300
URI: http://eprints.soton.ac.uk/id/eprint/453300
ISSN: 2044-6055
PURE UUID: 0e6938a1-efb8-4efd-a160-e4c7d2be26a1
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Date deposited: 12 Jan 2022 17:37
Last modified: 17 Mar 2024 04:11
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Contributors
Author:
Kathrin Louise Braeuninger-weimer
Author:
Naffis Anjarwalla
Author:
Alison H Mcgregor
Author:
Philip Sell
Author:
Tamar Pincus
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