School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Sydney School of Health Sciences, The University of Sydney, Sydney, Australia.
Pain. 2023 Dec 1;164(12):2749-2758. doi: 10.1097/j.pain.0000000000002975. Epub 2023 Jul 20.
Uncertainty pervades low back pain (LBP). This study aimed to explore individuals' experiences of navigating uncertainty when seeking care for their LBP, with a view to better understanding the contexts in which they experience uncertainty and gaining insight into how uncertainty may be better navigated during clinical encounters. We conducted 15 semistructured interviews with people who have experienced LBP. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Analysis produced 4 themes. To reflect the unsettled nature of participants' discussions of navigating uncertainty, themes are framed as questions: (1) What will happen over time?; (2) Can clinicians help me? Are they willing to?; (3) What are clinicians talking about?; and (4) Am I being taken seriously? Participants also discussed how clinicians could better navigate these uncertainties. Suggestions included making time to (actively) listen to, and acknowledge, patients' concerns; asking open-ended questions; being honest about uncertainty; creating management plans and returning to them; challenging assumptions; remaining curious about patients' context; and providing guidance on how to manage LBP rather than simply giving certainty that symptoms will worsen, lessen, or continue. These findings indicate that many of the uncertainties individuals with LBP experience are intertwined with relational aspects of their interactions with clinicians. Clinicians therefore may need to consider these broader and relational aspects of care when navigating uncertainty with people who experience LBP, bringing attention to the importance of drawing from knowledge produced outside of the usual hierarchy of evidence (eg, systematic reviews and randomised controlled trials).
下背痛 (LBP) 充满不确定性。本研究旨在探索个体在寻求 LBP 治疗时应对不确定性的体验,以期更好地了解他们经历不确定性的背景,并深入了解如何在临床接触中更好地应对不确定性。我们对 15 名有 LBP 经历的人进行了半结构化访谈。访谈内容进行了录音、转录,并使用反思性主题分析进行了分析。分析产生了 4 个主题。为了反映参与者在讨论应对不确定性时的不安定性质,主题被框定为问题:(1) 随着时间的推移会发生什么?;(2) 临床医生能帮助我吗?他们愿意吗?;(3) 临床医生在谈论什么?;以及 (4) 我被认真对待了吗?参与者还讨论了临床医生如何更好地应对这些不确定性。建议包括花时间(主动)倾听并承认患者的担忧;提出开放式问题;诚实地对待不确定性;制定管理计划并定期回顾;挑战假设;对患者的背景保持好奇;以及提供关于如何管理 LBP 的指导,而不是简单地保证症状会恶化、减轻或持续。这些发现表明,许多 LBP 患者经历的不确定性与他们与临床医生互动的关系方面交织在一起。因此,临床医生在与经历 LBP 的人一起应对不确定性时,可能需要考虑到这些更广泛和关系方面的护理,关注从证据常规之外的知识中汲取的重要性(例如,系统评价和随机对照试验)。