Discharged and dismissed: A qualitative study with back pain patients discharged without treatment from orthopaedic consultations
Discharged and dismissed: A qualitative study with back pain patients discharged without treatment from orthopaedic consultations
Background
Consultation-based reassurance for patients with low back pain (LBP) in primary care has been shown to be associated with patients' outcomes. Little is known about the role of reassurance in people with LBP consulting with orthopaedic spinal care teams. Reassurance may be important, especially in cases where surgery is not indicated and patients are discharged without treatment.
Methods
Semi-structured interviews were conducted with 30 patients with chronic disabling musculoskeletal LBP who had recently consulted with spinal orthopaedic care teams. Interviews were audio recorded, transcribed, coded and analysed.
Results
Most patients reported feeling dismissed and discouraged. Patients perceived that they needed specific behaviours from practitioners in order to feel sufficiently reassured to commit to self-management. These behaviours group into four domains: “Knowing my whole story” (evidence that practitioners read the case notes; were familiar with the patients' previous health care history; carried out tests and a physical examination and gathered information about the patients' lifestyle), “Seeing the right person” (showing empathy; listening; building rapport and demonstrating that they are qualified and experienced), “Nothing to worry about” (reducing generic reassuring statements but increasing validating statements recognizing suffering) and “Getting to grips with my problem” (providing explanations and a clear management plan). In the absence of these behaviours, patients rejected advice to self-manage, reported distress, anger and intention to re-consult.
Conclusion
Effective communication with patients attending spinal orthopaedic care settings is important, especially when no active treatment is being offered.
Significance
This study describes narratives from patients discharged without surgery following consultations with orthopaedic professionals for persistent and debilitating lower back pain. Findings suggest that these interactions are distressful to patients, and that patients require comprehensive and specific reassurance to promote self-management. The findings contribute a unique insight into the special needs of people with complex pain problems and provide guidance to improve consultation-based reassurance in orthopaedic spinal care settings.
1464-1474
Braeuninger-Weimer, Kathrin
68e2ec85-e120-4819-a83b-5960d6c8492d
Anjarwalla, Naffis
acf45c42-ee96-491c-9225-1fec6090a0db
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
9 May 2019
Braeuninger-Weimer, Kathrin
68e2ec85-e120-4819-a83b-5960d6c8492d
Anjarwalla, Naffis
acf45c42-ee96-491c-9225-1fec6090a0db
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Braeuninger-Weimer, Kathrin, Anjarwalla, Naffis and Pincus, Tamar
(2019)
Discharged and dismissed: A qualitative study with back pain patients discharged without treatment from orthopaedic consultations.
European Journal of Pain, 23 (8), .
(doi:10.1002/ejp.1412).
Abstract
Background
Consultation-based reassurance for patients with low back pain (LBP) in primary care has been shown to be associated with patients' outcomes. Little is known about the role of reassurance in people with LBP consulting with orthopaedic spinal care teams. Reassurance may be important, especially in cases where surgery is not indicated and patients are discharged without treatment.
Methods
Semi-structured interviews were conducted with 30 patients with chronic disabling musculoskeletal LBP who had recently consulted with spinal orthopaedic care teams. Interviews were audio recorded, transcribed, coded and analysed.
Results
Most patients reported feeling dismissed and discouraged. Patients perceived that they needed specific behaviours from practitioners in order to feel sufficiently reassured to commit to self-management. These behaviours group into four domains: “Knowing my whole story” (evidence that practitioners read the case notes; were familiar with the patients' previous health care history; carried out tests and a physical examination and gathered information about the patients' lifestyle), “Seeing the right person” (showing empathy; listening; building rapport and demonstrating that they are qualified and experienced), “Nothing to worry about” (reducing generic reassuring statements but increasing validating statements recognizing suffering) and “Getting to grips with my problem” (providing explanations and a clear management plan). In the absence of these behaviours, patients rejected advice to self-manage, reported distress, anger and intention to re-consult.
Conclusion
Effective communication with patients attending spinal orthopaedic care settings is important, especially when no active treatment is being offered.
Significance
This study describes narratives from patients discharged without surgery following consultations with orthopaedic professionals for persistent and debilitating lower back pain. Findings suggest that these interactions are distressful to patients, and that patients require comprehensive and specific reassurance to promote self-management. The findings contribute a unique insight into the special needs of people with complex pain problems and provide guidance to improve consultation-based reassurance in orthopaedic spinal care settings.
This record has no associated files available for download.
More information
Published date: 9 May 2019
Additional Information:
© 2019 European Pain Federation ‐ EFIC®
Identifiers
Local EPrints ID: 469389
URI: http://eprints.soton.ac.uk/id/eprint/469389
ISSN: 1090-3801
PURE UUID: cc6c295c-d3c8-49d0-bf45-583a9d777806
Catalogue record
Date deposited: 14 Sep 2022 16:40
Last modified: 17 Mar 2024 04:11
Export record
Altmetrics
Contributors
Author:
Kathrin Braeuninger-Weimer
Author:
Naffis Anjarwalla
Author:
Tamar Pincus
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics