White Kathy B, Lee John, de C Williams Amanda C
Central and North West London NHS Foundation Trust.
School of Life and Medical Sciences, University College London.
J Pain Res. 2016 Nov 28;9:1109-1120. doi: 10.2147/JPR.S119851. eCollection 2016.
The first consultation at a specialist pain clinic is potentially a pivotal event in a patient's pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors' messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem.
Sixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient-doctor dyads' understandings of the consultation messages.
Patients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals.
Overall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did) that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues often generate divergence of understanding or agreement. Despite the widespread recommendations to medical practitioners to check patients' understanding directly, it does not appear to be routine practice.
It is hoped that this research encourages more detailed examination of shared and divergent experiences of pain consultations and also their influence on the subsequent course of intervention and adherence to treatment (not addressed here).
在专科疼痛诊所的首次会诊可能是患者疼痛病史中的一个关键事件，会影响治疗依从性以及长期自我管理的参与度。医生就患者慢性疼痛向其传达的信息，以及患者在疼痛会诊中如何理解医生的信息和解释，目前研究不足，尤其是在专科护理方面。然而，患者重视有关其疼痛问题的个性化信息。
16名首次在专科疼痛诊所会诊的患者及其会诊医生在会诊后不久接受了访谈。采用基于患者主题的框架分析，以确定医患双方对会诊信息的理解是完全匹配、部分匹配还是不匹配。
患者和医生主要是隐含地达成一致，即旨在缓解疼痛的医疗治疗是首要的，且很少有时间用于讨论自我管理。临床上不匹配的相关领域包括疼痛的解释、医疗治疗提供缓解的可能性、长期治疗计划以及期望患者在实现治疗目标方面积极参与的程度。
总体而言，医患之间似乎有合理的一致性，患者对首次专科会诊普遍满意。有两个主题存在严重不匹配，即下一次计划干预的估计可能结果，以及假设（医生这样假设但患者不这样假设）该干预不成功时的长期治疗计划。似乎更复杂的问题往往会导致理解或共识上的分歧。尽管广泛建议医生直接检查患者的理解情况，但这似乎并非常规做法。
希望这项研究能促使人们更详细地审视疼痛会诊中共同的和不同的经历，以及它们对后续干预过程和治疗依从性的影响（本文未涉及）。
