Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Clinical Trials Unit, Keele University, Keele, UK.
BMC Musculoskelet Disord. 2023 Jan 2;24(1):1. doi: 10.1186/s12891-022-06059-1.
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.
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.
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.
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.
由于诊断不确定性、预后多变和长期治疗效果证据有限，肌肉骨骼肩部疼痛的临床管理具有挑战性。基于英国的 PANDA-S 计划（肩部的预后和诊断评估）正在调查肩部短期和长期疼痛的结果。本文报告了一项探索患者和临床医生对肩部疼痛初级保健咨询的看法的链接定性研究。
对 24 名患者和 15 名初级保健临床医生进行了半结构化访谈。进行了 22 次访谈（11 名患者，11 名临床医生），作为匹配的患者-临床医生“对子”。对数据进行了主题分析。
临床医生报告了试图让患者参与管理决策；然而，在患者是否更喜欢治疗选择，还是让决策由临床医生主导方面存在差异。一些患者对做出的决定感到不确定，因为缺乏对可用管理选择的讨论。许多全科医生对诊断肩部疼痛的根本原因缺乏信心。患者报告要么没有得到诊断，要么从不同的专业人员那里得到不同的诊断，导致混淆。虽然临床医生报告通常会讨论肩部疼痛的预后，但患者报告说预后没有提出。患者还表示担心他们的肩部疼痛可能是由严重的病理引起的；然而，临床医生认为这不是患者常见的担忧。
研究结果表明，患者和临床医生对肩部疼痛咨询的看法存在差异，表明需要改善医患沟通。研究结果将为支持肩部疼痛治疗和转诊决策的干预措施的设计提供信息，该干预措施将在随机对照试验中进行测试。
