Patients’ and clinicians’ perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme
Patients’ and clinicians’ perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme
Background: clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients' and clinicians' views towards primary care consultations for shoulder pain.
Methods: semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician 'dyads'. Data were analysed thematically.
Results: clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion about available management options. Many General Practitioners expressed a lack of confidence in diagnosing the underlying cause of shoulder pain. Patients reported either not being given a diagnosis, or receiving different diagnoses from different professionals, resulting in confusion. Whilst clinicians reported routinely discussing prognosis of shoulder pain, patients reported that prognosis was not raised. Patients also expressed concern that their shoulder pain could be caused by serious pathology; however, clinicians felt that this was not a common concern for patients.
Conclusions: findings showed disparities between patients' and clinicians' views towards shoulder pain consultations, indicating a need for improved patient-clinician communication. Findings will inform the design of an intervention to support treatment and referral decisions for shoulder pain that will be tested in a randomised controlled trial.
Diagnosis, General practice, Primary care, Prognosis, Qualitative, Shoulder pain
Saunders, B.
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Burton, C.
777daf74-8e6c-46f5-bc9e-97942cc3d19a
van der Windt, D.
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Myers, H.
9e8c324b-6552-4467-a748-6e547296f846
Chester, R.
5bd29bff-a919-428e-b9d2-8139938c2d71
Pincus, T.
55388347-5d71-4fc0-9fd2-66fbba080e0c
Wynne-Jones, G.
48fa6391-16e4-4668-8ded-b99d97fe8d7c
2 January 2023
Saunders, B.
732178dd-ed10-4bad-acc9-cc2f1b4d35a3
Burton, C.
777daf74-8e6c-46f5-bc9e-97942cc3d19a
van der Windt, D.
485ceb57-c61f-4698-b865-101b65341f6d
Myers, H.
9e8c324b-6552-4467-a748-6e547296f846
Chester, R.
5bd29bff-a919-428e-b9d2-8139938c2d71
Pincus, T.
55388347-5d71-4fc0-9fd2-66fbba080e0c
Wynne-Jones, G.
48fa6391-16e4-4668-8ded-b99d97fe8d7c
Saunders, B., Burton, C., van der Windt, D., Myers, H., Chester, R., Pincus, T. and Wynne-Jones, G.
(2023)
Patients’ and clinicians’ perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme.
BMC Musculoskeletal Disorders, 24 (1), [1].
(doi:10.1186/s12891-022-06059-1).
Abstract
Background: clinical management of musculoskeletal shoulder pain can be challenging due to diagnostic uncertainty, variable prognosis and limited evidence for long-term treatment benefits. The UK-based PANDA-S programme (Prognostic And Diagnostic Assessment of the Shoulder) is investigating short and long-term shoulder pain outcomes. This paper reports linked qualitative research exploring patients' and clinicians' views towards primary care consultations for shoulder pain.
Methods: semi-structured interviews were conducted with 24 patients and 15 primary care clinicians. Twenty-two interviews (11 patients, 11 clinicians) were conducted as matched patient-clinician 'dyads'. Data were analysed thematically.
Results: clinicians reported attempts to involve patients in management decisions; however, there was variation in whether patients preferred treatment choice, or for decisions to be clinician-led. Some patients felt uncertain about the decisions made, due to a lack of discussion about available management options. Many General Practitioners expressed a lack of confidence in diagnosing the underlying cause of shoulder pain. Patients reported either not being given a diagnosis, or receiving different diagnoses from different professionals, resulting in confusion. Whilst clinicians reported routinely discussing prognosis of shoulder pain, patients reported that prognosis was not raised. Patients also expressed concern that their shoulder pain could be caused by serious pathology; however, clinicians felt that this was not a common concern for patients.
Conclusions: findings showed disparities between patients' and clinicians' views towards shoulder pain consultations, indicating a need for improved patient-clinician communication. Findings will inform the design of an intervention to support treatment and referral decisions for shoulder pain that will be tested in a randomised controlled trial.
Text
s12891-022-06059-1
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More information
Accepted/In Press date: 6 December 2022
e-pub ahead of print date: 2 January 2023
Published date: 2 January 2023
Additional Information:
Funding Information:
This study is linked to an 8-year research programme funded by the UK National Institute for Health Research (NIHR) and Versus Arthritis: Prognostic And Diagnostic Assessment of the Shoulder (PANDA-S). PANDA-S is investigating the short and long-term outcomes of shoulder pain, with the aim of informing the design of an intervention to support clinicians and patients to make optimal decisions regarding self-management, treatment and referral. A longitudinal cohort study is currently being undertaken of 492 patients with shoulder pain presenting to UK NHS general practices and physiotherapy services []. Participants invited to take part in the qualitative study were recruited from the cohort (see Recruitment and Sampling for details).
Funding Information:
This study is funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme in collaboration with Versus Arthritis (RP-PG-0615-20002). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Publisher Copyright:
© 2023, The Author(s).
Keywords:
Diagnosis, General practice, Primary care, Prognosis, Qualitative, Shoulder pain
Identifiers
Local EPrints ID: 483475
URI: http://eprints.soton.ac.uk/id/eprint/483475
ISSN: 1471-2474
PURE UUID: 347c10e5-1d13-4b16-bb1c-837519296fd7
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Date deposited: 31 Oct 2023 17:58
Last modified: 18 Mar 2024 04:05
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Contributors
Author:
B. Saunders
Author:
C. Burton
Author:
D. van der Windt
Author:
H. Myers
Author:
R. Chester
Author:
T. Pincus
Author:
G. Wynne-Jones
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