Braeuninger-Weimer Kathrin, Anjarwalla Naffis, Pincus Tamar
Department of Psychology, Royal Holloway, University of London, Egham, UK.
Department of Orthopaedics, Wexham Park Hospital, Slough, UK.
Eur J Pain. 2019 Sep;23(8):1464-1474. doi: 10.1002/ejp.1412. Epub 2019 May 28.
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.
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.
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.
Effective communication with patients attending spinal orthopaedic care settings is important, especially when no active treatment is being offered.
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.
在初级医疗保健中，基于咨询的对腰痛（LBP）患者的安慰已被证明与患者的治疗结果相关。对于向脊柱骨科护理团队咨询的腰痛患者，安慰所起的作用知之甚少。安慰可能很重要，尤其是在不建议手术且患者未经治疗就出院的情况下。
对30名患有慢性致残性肌肉骨骼性腰痛且最近咨询过脊柱骨科护理团队的患者进行了半结构化访谈。访谈进行了录音、转录、编码和分析。
大多数患者表示感觉被忽视和气馁。患者认为他们需要从业者表现出特定行为，才能感到足够安心从而致力于自我管理。这些行为可分为四个方面：“了解我的全部情况”（有证据表明从业者阅读了病例记录；熟悉患者以前的医疗保健史；进行了检查和体格检查并收集了患者生活方式的信息），“见到合适的人”（表现出同理心；倾听；建立融洽关系并表明他们有资质且经验丰富），“无需担忧”（减少一般性的安慰性话语，但增加认可痛苦的确认性话语）以及“着手解决我的问题”（提供解释和明确的管理计划）。如果没有这些行为，患者会拒绝自我管理的建议，报告痛苦、愤怒并打算再次咨询。
与前往脊柱骨科护理机构就诊的患者进行有效沟通很重要，尤其是在不提供积极治疗的情况下。
本研究描述了在因持续性和使人衰弱的下背部疼痛向骨科专业人员咨询后未接受手术而出院的患者的叙述。研究结果表明，这些互动让患者感到痛苦，并且患者需要全面而具体的安慰来促进自我管理。这些发现为有复杂疼痛问题的人群的特殊需求提供了独特见解，并为改善脊柱骨科护理机构中基于咨询的安慰提供了指导。
