White, KB; (2012) How do patients and doctors make sense of chronic back pain in the first specialist consultation? Doctoral thesis , UCL (University College London).

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Abstract

Aim: This paper aimed to examine how patients with chronic back pain understand and experience the messages about pain and treatment in their first specialist medical (pain clinic) consultation. It also aimed to compare what doctors believe they communicated with patients’ own ‘take home’ messages. Method: Sixteen patients were interviewed immediately after their first consultation at a pain clinic, and their corresponding doctors were interviewed shortly afterwards. Thematic analysis was conducted on the patient interviews to address the first research aim, and then framework analysis was employed to compare understandings of the consultation within the patient-doctor dyads. Results: Thematic analysis of patient interviews resulted in four higher-order themes: the central role of medical treatments in the treatment of pain; a dilemma about hoping when there are ‘no guarantees’; the importance of trying all recommended medical interventions and, for a minority of patients, relief to be recommended non-medical pain management. Although there was considerable overlap within the patient-doctor dyads, clinically relevant areas of mismatch included the explanation of pain, the likely long-term treatment plan, and patients’ role in their treatment. Conclusions: Patients’ understandings of the consultation messages seemed to influence their beliefs about the likelihood of their pain being relieved, and their sense of control over it. There seemed notable areas of mismatch between doctors’ and patients’ understandings of the consultation which are likely to impact upon treatment success and patient satisfaction.

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