Patients’ and clinicians’ perspectives towards primary care consultations for shoulder pain: qualitative findings from the Prognostic and Diagnostic Assessment of the Shoulder (PANDA-S) programme

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

“I wanted to know what was hurting so much”: a qualitative study exploring patients’ expectations and experiences with primary care management

“…Participants were less satisfied when they felt that the clinician did not take enough time with them or when they did not receive enough explanations related to the prognosis or their treatment options. These findings are in agreement with a recent study indicating that patients expect a detailed discussion on management options and prognosis and they expected to receive also reassurance in relation to their health problem [ 27 ]. Participants from our study felt satisfied when the primary care clinician offered them treatment options, including exercises.…”

“…However, because of the long pain duration and time since the first consultation, we had a broader view of participants’ experiences in primary care for shoulder pain compared to participants that would have just recently consulted for their shoulder pain. Another limitation of our study is that patients knew that the interviews were performed by a physiotherapist, which may have influenced their responses, but our results are fairly consistent with other studies exploring patients’ experiences of shoulder pain management [ 19 , 27 ]. Also, our interview guide was not reviewed by stakeholders.…”

“…This raises some concerns since long-lasting symptoms and severe pain are associated with a poorer prognosis [ 5 , 6 ]. Other qualitative studies on the experiences of patients living with shoulder pain did not report that participants waited for a significant amount of time before consulting a care provider, or that they did not feel confident that something could be done to manage their pain [ 19 , 27 ]. However, there have been previous reports that patients with various medical conditions often avoid seeking medical care because of unfavourable experiences, a low perception of the need to seek care, or because they thought that symptoms would improve over time [ 38 – 40 ].…”

“…However, the explanations on the diagnosis were often considered lacking, leaving patients with the impression that they still did not clearly understand the cause of their shoulder pain. Participants from a previous study also reported that no diagnostic was provided, that the clinician demonstrated uncertainty in explaining the diagnosis or that the family physician would rely on diagnostic imaging to confirm the source of shoulder pain [ 27 ]. Moreover, many participants from our study were referred for diagnostic imaging instead of having their condition clearly explained or having a full clinical assessment.…”

“…Patients’ expectations and experiences of shoulder pain management have mostly been studied for specific shoulder conditions, such as adhesive capsulitis, or for a specific approach, such as exercise therapy [ 19 ]. To our knowledge, there is only one qualitative study on patients’ perspectives of primary care for shoulder pain and participants identified that receiving a diagnosis, discussing management options and prognosis as well as the need for reassurance were their priorities [ 27 ]. Moreover, there has been no study on patients’ opinions of shoulder primary care management within the Canadian healthcare system.…”