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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

Authors :
Philip Sell
Alison H McGregor
Tamar Pincus
Lisa Roberts
Kathrin Louise Braeuninger-Weimer
Naffis Anjarwalla
Source :
BMJ Open, Vol 11, Iss 9 (2021)
Publication Year :
2021
Publisher :
BMJ Publishing Group, 2021.

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.

Subjects

Subjects :
Medicine

Details

Language :
English
ISSN :
20446055
Volume :
11
Issue :
9
Database :
Directory of Open Access Journals
Journal :
BMJ Open
Publication Type :
Academic Journal
Accession number :
edsdoj.69d0cb2267624c919f0b4eee725ba2e6
Document Type :
article
Full Text :
https://doi.org/10.1136/bmjopen-2021-052938