“I had already tried that before going to the doctor” – exploring adolescents’ with knee pain perspectives on ‘wait and see’ as a management strategy in primary care; a study with brief semi-structured qualitative interviews

Abstract

Objectives The aim of this study was to examine how the “wait-and-see” recommendation affects adolescents’ understanding of their illness and symptoms and their care-seeking behavior. Methods This study included brief qualitative, semi-structured online interviews. Adolescents (age 10–19 years) with long-term knee pain, who had been recommended “wait-and-see” by their general practitioner (GP), were recruited via previous studies and social media. Two researchers conducted brief semi-structured interviews through Microsoft Teams. An interview guide with open questions was created prior to the interviews and updated as new questions emerged. The extracted data was transcribed and analyzed via a reflexive thematic approach in NVivo. Results Eight adolescents (mean age 17.8) with longstanding or recurrent knee pain (mean duration 3.5 years) were included. The analysis identified four main themes: (1) The perception of wait and see over time, (2) The GP’s acknowledgement and consideration, (3) experienced limitation from knee pain and (4) the importance of getting a diagnosis. The perception of “wait-and-see” approach changed from positive to negative when adolescents received the recommendation multiple times. Adolescents experienced frustration with their situation and a lack of consideration from their GP made them cautious about seeking additional care. Knee pain significantly limited the adolescents’ physical-and social activities. Receiving a diagnosis was important and helped adolescents dealing with their pain. Conclusions The connotation of wait-and-see changed from positive to negative for adolescents when receiving the recommendation multiple times. The participants felt getting a clinical diagnosis was a relief. Furthermore, the lack of consideration and acknowledgement from the GP plays an essential role in the adolescent’s understanding of their knee pain. Implications Recommending adolescents to “wait-and-see” multiple times in relation to their knee problems can lead adolescents experience frustration and a lack of consideration from their GP. It would be advisable for GPs to provide adolescents with a diagnosis as it can facilitate them in dealing with their pain and to use simple language when explaining adolescents their condition to improve communication.

The Effectiveness of Using a Clinical Support Tool in Managing Adolescents with Non-Traumatic Knee Pain (MAP-Knee): protocol for a cluster-randomised superiority trial with delayed intervention and embedded realist evaluation

“…This trial focuses on how the initial clinical encounter and clinicians' decision-making can be improved to meet the support and management needs of adolescents with chronic knee pain seeking treatment for knee pain in secondary care. Previous studies have highlighted how adolescents' formation of self-management strategies does not occur within a vacuum (48) and how the lack of validation from HCPs, peers and parents, uncertainty about the severity of the condition, excessive use of diagnostic imaging and 'watchful waiting' without explanations may negatively influence adolescents' formation of strategies for mastering their knee pain (49)(50)(51)(52). Contrarily, patients highlight how validation from clinicians, a name, and an explanation for why their knee pain emerged enabled adolescents to adjust their pain beliefs and commence the work related to accepting and exploring how to self-manage their knee pain in everyday situations (52).…”

Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study

“…The young adults highlighted how GP and parental support had helped them to accept their knee pain and take on the role as explorers [ 34 ] and how experiencing having their requests rejected—real or perceived—increased doubts, dissatisfaction, and stagnation and prompted withdrawal, as observed in adults and youths with chronic pain [ 89 - 91 ]. Our analysis revealed how entering into treatment led to the emergence of a complex triadic relationship, where patients, parents, and GPs took on different roles, tasks, and responsibilities, similar to what Brooker [ 58 ] and Hohmann [ 57 ] outlined in the collaborative care triangle and what Kanstrup et al [ 92 ] presented as a complex interplay.…”

Development of a clinical decision-support tool for Management of Adolescent knee Pain (The MAP-Knee Tool)

“…(38) Adolescents may become confused and have difficulties understanding their condition if they sense diagnostic uncertainty among the clinician or do not understand the information provided. (39)(40)(41)(42) From our experiences with the MAP-Knee Tool, we learned that developing targeted patient information is complex as explanations must be individualised and generalisable. To overcome this, we advise clinicians to use the tool as a guide and support tool but also include phrases and explanations tailored to each individual adolescent.…”