Maxwell Christina, McCreesh Karen, Salsberg Jon, Robinson Katie
School of Allied Health, Faculty of Education and Health Science, University of Limerick, Limerick, Ireland.
Health Research Institute, Faculty of Education and Health Science, University of Limerick, Limerick, Ireland.
Health Expect. 2022 Jun;25(3):1108-1117. doi: 10.1111/hex.13464. Epub 2022 Mar 15.
Many inconsistencies have been identified in the translation of evidence-based treatment recommendations for musculoskeletal shoulder pain into healthcare services, with little known about factors influencing decision-making. The objective of this study was to explore the views and experiences of healthcare providers (HCPs) and people living with shoulder pain on treatment decision-making.
Adopting a qualitative design, purposeful sampling was employed to recruit 13 individuals with nonspecific musculoskeletal shoulder pain and 30 HCPs. Data were collected through 1:1 semi-structured interviews and analysed using an approach informed by Constructivist Grounded Theory. To facilitate analysis, two patient and public involvement (PPI) meetings were conducted.
Most participants (69%) had shoulder pain of ≥1-year duration. Biomechanical beliefs about shoulder pain predominated and were heavily influential in decision-making for both patients and HCPs. Despite a consensus that therapeutic alliance facilitated decision-making, the extent of collaboration between HCPs and patients in treatment decision-making was rather limited. In addition to condition-specific factors, Individual patient characteristics and resources also influenced treatment decisions.
Findings revealed the complexity of the decision-making process for both patients and HCPs, exposing substantial gaps between the reported views and experiences of participants and the principles of client-centred and evidence-based practice. There is a pressing need to enhance the translation of evidence-based knowledge into practice in this clinical area.
In line with a consultative approach to collaborative data analysis, a subgroup of participants attended two PPI meetings to provide commentary and feedback on preliminary findings.
在将基于证据的肩部肌肉骨骼疼痛治疗建议转化为医疗服务的过程中，已发现诸多不一致之处，而对于影响决策的因素却知之甚少。本研究的目的是探讨医疗服务提供者（HCPs）和肩部疼痛患者在治疗决策方面的观点和经验。
采用定性设计，通过目的抽样法招募了13名非特异性肩部肌肉骨骼疼痛患者和30名医疗服务提供者。通过一对一的半结构化访谈收集数据，并采用建构主义扎根理论进行分析。为便于分析，组织了两次患者和公众参与（PPI）会议。
大多数参与者（69%）肩部疼痛持续时间≥1年。关于肩部疼痛的生物力学观念占主导地位，对患者和医疗服务提供者的决策都有很大影响。尽管大家一致认为治疗联盟有助于决策，但医疗服务提供者与患者在治疗决策中的合作程度相当有限。除了特定病情因素外，患者的个体特征和资源也会影响治疗决策。
研究结果揭示了患者和医疗服务提供者决策过程的复杂性，凸显了参与者报告的观点和经验与以患者为中心和基于证据的实践原则之间的巨大差距。在这一临床领域，迫切需要加强将基于证据的知识转化为实践。
按照合作数据分析的协商方法，一组参与者参加了两次患者和公众参与会议，对初步研究结果提供评论和反馈。
