Surgical consultations for chronic low back: a mixed methods study
File(s)
Author(s)
Poyton, Ross
Type
Thesis
Abstract
Abstract
Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide and is recognised as a complex multidimensional disorder. Despite evidence-based guidelines making recommendations on the clinical assessment and management of CLBP, the gap between guidelines and clinical practice is well documented. This research aims to close the gap by analysing the interaction between patients’ with CLBP and consultants managing these patients. This study also captures the subjective experience of both participants (patients/consultants).
Methods: Mixed qualitative methods were employed in this PhD thesis. Conversation Analysis (Chapter 3) was used to analyse the communication practices in the patient-clinician initial encounter for patients who presented with CLBP. The perceptions of patients’ (Chapter 4) and the neurosurgery consultants (Chapter 5) were gathered through interviews and evaluated using reflexive thematic analysis. These data were triangulated to provide deeper understanding, and to provide insight into management gaps.
Results: The Conversation Analysis study (Chapter 3) highlighted the interactional difficulties consultants face when explaining symptoms in non-surgical cases of CLBP in contrast to surgical cases. The patient experience study (Chapter 4) demonstrated that patient’s experiences were related to whether they were deemed to be a surgical or non-surgical case. Themes such as hope, understanding their problem and feeling listened to influenced patient experience and were reduced in non-surgical cases. In chapter 5, the consultants highlighted the challenges of managing non-surgical cases and attributed this to their lack of training in a BPS model of care, unrealistic patient expectations and inappropriate referrals to a surgical service...
Background: Chronic low back pain (CLBP) is a leading cause of disability worldwide and is recognised as a complex multidimensional disorder. Despite evidence-based guidelines making recommendations on the clinical assessment and management of CLBP, the gap between guidelines and clinical practice is well documented. This research aims to close the gap by analysing the interaction between patients’ with CLBP and consultants managing these patients. This study also captures the subjective experience of both participants (patients/consultants).
Methods: Mixed qualitative methods were employed in this PhD thesis. Conversation Analysis (Chapter 3) was used to analyse the communication practices in the patient-clinician initial encounter for patients who presented with CLBP. The perceptions of patients’ (Chapter 4) and the neurosurgery consultants (Chapter 5) were gathered through interviews and evaluated using reflexive thematic analysis. These data were triangulated to provide deeper understanding, and to provide insight into management gaps.
Results: The Conversation Analysis study (Chapter 3) highlighted the interactional difficulties consultants face when explaining symptoms in non-surgical cases of CLBP in contrast to surgical cases. The patient experience study (Chapter 4) demonstrated that patient’s experiences were related to whether they were deemed to be a surgical or non-surgical case. Themes such as hope, understanding their problem and feeling listened to influenced patient experience and were reduced in non-surgical cases. In chapter 5, the consultants highlighted the challenges of managing non-surgical cases and attributed this to their lack of training in a BPS model of care, unrealistic patient expectations and inappropriate referrals to a surgical service...
Version
Open Access
Date Issued
2024-02-29
Date Awarded
01/12/2024
License URL
Advisor
McGregor, Professor Alison
Sponsor
North East London NHS Foundation Trust
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)