No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
What does the language we use about arthritis mean to people who have osteoarthritis? A qualitative study
Abstract
Purpose:
To explore the meanings and issues surrounding the use of existing medical terms for osteoarthritis from the perspective of members of the public who have consulted healthcare practitioners for arthritic symptoms and from lay people who have not sought a consultation.
Methods:
Five qualitative focus groups of 6-8 respondents and six individual in-depth interviews were conducted amongst a purposive sample of men and women aged 45 years and over, with a spread of and a range of socio-economic groupings. Key terms were used as stimulus materials. Focus groups and individual interviews were audio taped, fully transcribed and underwent line by line analysis, identifying concepts and coded.
Results:
Patients were familiar with many of the terms such as arthritis, osteoarthritis, rheumatism, inflammation, etc. but their level of comprehension varied. Most terms had little emotional impact. Terms used to describe pathophysiology elicited negative emotional impact, especially in women. Terms such as rehabilitation and "self management" were poorly understood and produced negative emotional impact.
Conclusions:
Healthcare professionals should not assume that patients' familiarity with medical terms correlate to understanding the term. They should be aware of the potential for negative emotional impact related to some terms. Implications for Rehabilitation Few of the existing medical terms were understood and accepted by lay participants in the way discussed and expected by health professionals. Misunderstandings, unintended meanings and negative emotional responses to terms were common within the study focus groups. Cutting the jargon and checking understanding of seemingly simple medical terms is important to improve communication with patients. As patient access to treatment notes and correspondence increases in the UK, the impact of written terms, as well as verbal, needs careful consideration and attention.
... This study is the first to describe common use of jargon and complex language in a pediatric otolaryngology or surgical setting. Our results reflect those of prior studies emphasizing jargon in other adult medical fields, including osteoarthritic [45], rheumatologic, [45,46] diabetic, [16,25] gynecologic, [26] and oncologic [17,20] clinical settings. Similar to previous research, chief complaint jargon and other medical terminology are used across consults in pediatric otolaryngology, regardless of parental characteristics. ...
... This study is the first to describe common use of jargon and complex language in a pediatric otolaryngology or surgical setting. Our results reflect those of prior studies emphasizing jargon in other adult medical fields, including osteoarthritic [45], rheumatologic, [45,46] diabetic, [16,25] gynecologic, [26] and oncologic [17,20] clinical settings. Similar to previous research, chief complaint jargon and other medical terminology are used across consults in pediatric otolaryngology, regardless of parental characteristics. ...
... [12] Not only do parents have negative reactions to jargon, many demonstrate lack of comprehension of clinician language. [21,23,45] Furthermore, when multiple clinicians examine a patient concurrently in the same encounter (e.g., medical doctor and nurse practitioner), they have a tendency to use exclusionary jargon terms with each other when discussing clinical status in front of the patient, [48] impacting the opportunity for shared decision-making. Given evidence of negative parental reactions to jargon, and dissonance between clinicians' perception and patients' experience, our findings have implications for practice. ...
Objective:
Unexplained medical terminology impedes clinician/parent communication. We describe jargon use in a pediatric surgical setting.
Methods:
We evaluated encounters between parents of children with sleep-disordered breathing (SDB; n = 64) and otolaryngologists (n = 8). Participants completed questionnaires evaluating demographics, clinical features, and parental role in decision-making via a 4-point categorical item. Two coders reviewed consultations for occurrence of clinician and parent utterance of medical jargon. Descriptive statistics established a profile of jargon use, and logistic regression evaluated associations between communication factors with jargon use.
Results:
Unexplained medical jargon was common (mean total utterances per visit = 28.9,SD = 19.5,Range = 5-100), including SDB-specific jargon (M = 8.3,SD = 8.8), other medical terminology (M = 13.9,SD = 12) and contextual terms (M = 3.8,SD = 4). Parents used jargon a mean of 4.3 times (SD = 4.6). Clinicians used more jargon in consults where they perceived parents as having greater involvement in decision-making (OR = 3.4,p < 0.05) and when parents used more jargon (OR = 1.2,p < 0.05).
Conclusions:
Jargon use in pediatric surgical consultations is common and could serve as a barrier to informed or shared parent decision-making. This study provides a foundation for further research into patterns of jargon use across surgical populations.
Practice implications:
Results will be integrated into communication training to enhance clinician communication, foster self-awareness in language use, and create strategies to evaluate parental understanding.
... The descriptive characteristics of the included studies is shown in Table 1. The majority of studies were conducted in the United Kingdom [25,30,35,36,39,42,44,47,49,50], with the remainder from Europe [22,26,28,31,32,37,41,45,46,48], North America [27,33,43,51], South-East Asia [29,40], Australia [38], Middle-East [23] and an unknown source [24]. ...
... Four studies reported that patients were dissatisfied with the unclear explanations provided by healthcare providers regarding their OA [22,[25][26][27]. Barker found that many terms used in OA were misunderstood by patients or had different connotations, such as "rheumatism", "inflammation", "cartilage" and "rehabilitation" [25]. ...
... Four studies reported that patients were dissatisfied with the unclear explanations provided by healthcare providers regarding their OA [22,[25][26][27]. Barker found that many terms used in OA were misunderstood by patients or had different connotations, such as "rheumatism", "inflammation", "cartilage" and "rehabilitation" [25]. Moreover, patients reported negative connotations with a number of words and phrases. ...
Background
Optimal management of osteoarthritis requires active patient participation. Understanding patients’ perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients’ perceived health information needs for OA.
Methods
A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs of osteoarthritis health information were categorized.
Results
30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention.
Conclusions
Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes.
... The descriptive characteristics of the included studies is shown in Table 1. The majority of studies were conducted in the United Kingdom [25,30,35,36,39,42,44,47,49,50], with the remainder from Europe [22,26,28,31,32,37,41,45,46,48], North America [27,33,43,51], South-East Asia [29,40], Australia [38], Middle-East [23] and an unknown source [24]. ...
... Four studies reported that patients were dissatisfied with the unclear explanations provided by healthcare providers regarding their OA [22,[25][26][27]. Barker found that many terms used in OA were misunderstood by patients or had different connotations, such as "rheumatism", "inflammation", "cartilage" and "rehabilitation" [25]. ...
... Four studies reported that patients were dissatisfied with the unclear explanations provided by healthcare providers regarding their OA [22,[25][26][27]. Barker found that many terms used in OA were misunderstood by patients or had different connotations, such as "rheumatism", "inflammation", "cartilage" and "rehabilitation" [25]. Moreover, patients reported negative connotations with a number of words and phrases. ...
... With an improved understanding of the public, we aim to educate healthcare practitioners about more effective communication. A secondary aim was to better understand how to study jargon in the future, as existing studies of patient understanding typically rely on the patient reading a prompt and then reacting to it (6,(10)(11)(12)(13); yet much of the jargon that patients are exposed to in clinical practice is spoken aloud. ...
... While most studies on medical jargon focus on patients' understanding of terminology (6)(7)(8)(9)(10)(11)(12) and quantify the use of jargon in clinical settings (1)(2)(3), this study looks at people's preferences on how clinicians communicate and why patients think they use jargon. Our findings revealed that in a large sample of the general public, over 90% of respondents preferred the doctor who used jargon-free language. ...
While it has been shown that healthcare providers often use medical jargon, less is known about how patients prefer their clinicians communicate. This mixed-methods study aimed to better understand the general public's preference in healthcare communication. A volunteer cohort of 205 adult attendees at the 2021 Minnesota State Fair was presented a survey with two scenarios at a doctor's office sharing the same information: one using medical terminology and one using simpler, jargon-free language. Survey participants were asked which doctor they preferred, to describe each doctor, and to explain why they believe that doctors may use medical terminology. Common descriptive themes for the jargon-using doctor included that this doctor caused confusion, was too technical, and was uncaring, while the doctor who spoke without jargon was perceived as a good communicator, caring/empathetic, and approachable. Respondents perceived a range of reasons why doctors use jargon, from not recognizing they are using words that are not understood to trying to make themselves feel more important. Overall, 91% of survey respondents preferred the doctor who communicated without medical jargon.
... 36,40,56,89 People's understanding of medical terms can lead them to adopt unhelpful coping strategies. 7,22,31 For example, people often associate arthritis with wear and tear, and wear and tear with irreversible damage, which exercise will not benefit or will worsen. 7,16,58 We found that people who viewed their hip pain through a biomedical lens or did not clearly understand what their hip pain was and what was causing it avoided activity and delayed seeking health care. ...
... 7,22,31 For example, people often associate arthritis with wear and tear, and wear and tear with irreversible damage, which exercise will not benefit or will worsen. 7,16,58 We found that people who viewed their hip pain through a biomedical lens or did not clearly understand what their hip pain was and what was causing it avoided activity and delayed seeking health care. ...
To enhance patient-centred care of people with hip pain, we need a comprehensive understanding of peoples' beliefs about their hip pain. This systematic review explored the beliefs and expectations of middle-aged and older adults about chronic hip pain and its care across different healthcare settings and contexts. This review was a synthesis of qualitative studies using a framework synthesis approach. We searched 5 databases: MEDLINE, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO. Two reviewers independently screened the studies for eligibility. We included qualitative studies that included people with a mean age of older than 45 years and 80% or more of the participants had chronic hip pain, or if they reported the data about participants with chronic hip pain who were 45 years or older separately. We excluded studies of people with systemic conditions and studies not published in English. We included 28 studies involving 352 participants with chronic hip pain. We generated 5 themes: (1) biomedical causes (subtheme 1: scary pathoanatomical labels, subtheme 2: information needs); (2) negative impacts on physical, social, and mental health; (3) activity avoidance or modification and rest; (4) treatment failures (subtheme: information and support were helpful); (5) surgery is inevitable. Middle-aged and older adults labelled their hip joint damaged and attributed their hip pain to age, and wear and tear. People coped with their hip pain by avoiding or modifying activity. People were not educated about treatments or used treatments that failed to improve their hip pain. People believed that surgery for their hip was inevitable.
... Arthritis-related research, for example, found that although patients were familiar with most medical terms, comprehension varied, highlighting that familiarity does not necessarily convey understanding. 18 Good communication will improve patient satisfaction with health care, and there is also strong evidence to indicate that it is necessary for patient recall, understanding, and adherence to treatment, 19,20 which may improve disease course and health outcomes. 21 Conversely, miscommunication may lead to patients misunderstanding their diagnosis and the severity of their illness, which can negatively affect patienteHCP relationships. ...
... 1,22 Experiences with other conditions such as cancer, arthritis, and obesity highlight the importance of exploring language, familiarity, understanding, and preferences for terminology among all stakeholders, including patients, for the successful management of clinical conditions. 5,18,23 There is a paucity of research on the use of malnutrition as a term in relation to HCPs' and patients' understanding and experience. Possibly misinterpretation or miscommunication could contribute to poor understanding among vulnerable cohorts. ...
Background:
Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored.
Objective:
This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition.
Design:
Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives.
Participants and setting:
HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4).
Data analysis:
Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis.
Results:
There was mutual agreement between HCPs and patients on the main theme, "malnutrition is a term to be avoided." There were three subthemes with varying input from the different HCP groups and patients: "Malnutrition is a term a patient doesn't want to hear"-malnutrition has negative connotations that imply neglect and stigma; "malnutrition is a clinical term which patients don't understand"-with perceptions that it is better to substitute the term with simpler motivating messages; and "lack of confidence identifying malnutrition"-expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients.
Conclusions:
HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.
... (5) Implementation of clinical care pathways for postfracture management, commonly referred to as orthogeriatric services or fracture liaison services, have been expanding globally over the last decade. (12) These services are interdisciplinary, combining orthopedic surgery, geriatric care, primary care, and ancillary services such as physical therapy, (13) and aim to ensure patients aged ≥50 years who present to hospital with a MOF receive the appropriate evaluation and treatment for osteoporosis in accordance with clinical guidelines. (14) Clinical care pathways have shown improvements in recovery of basic activities of daily living, (15) decreased refracture rates, (14) and improved HRQoL in hip fracture patients compared to usual care (16) ; however, there is significant variability among these care pathways in terms of the healthcare and community services offered to patients. ...
... In Russia, a five-class model was the most optimal fit for MOF participants. Class 4 and class 5 were both associated with increased odds of HRQoL recovery at 12 Table 2). ...
Major osteoporotic fractures (MOFs) are associated with a rapid decline of health-related quality of life (HRQoL), however there is limited knowledge about which health care services positively affect HRQoL post-fracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12-months post-MOF. The analyses included 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) - a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK). HRQoL at pre-fracture and 12-months post-fracture was measured using the EuroQoL questionnaire (EQ-5D-3L). Health service use data were collected via participant interviews and medical record reviews including in-hospital care; outpatient care; community services and medication use. Data analyses involved two stages: 1) latent class analyses to identify different combinations of health service use ("classes"); and 2) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non-hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their pre-fracture HRQoL at 12-month follow-up; this proportion was higher for non-hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range: 2-5 classes). Classes that were associated with increased odds of HRQoL recovery at 12-months were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non-opioid analgesic use. Similar classes were observed for non-hip MOFs. Understanding country-specific health care service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve post-fracture care on a global scale. This article is protected by copyright. All rights reserved.
... Similar misapprehensions are reported by patients with other types of arthritis, including osteoarthritis (25,49) and lupus (50). Some specific concerns were providers dismissing symptoms, minimizing symptom inference bothersome to patients (25), overly focusing on pharmaceuticals (49), perceived frustration by physicians when patient symptoms are not "textbook," lack of information (50), and confusion and negative emotional responses to unfamiliar terms (51). ...
... Clearly, there continues to be unmet need among the public for trusted sources to communicate accurate information regarding various types and consequences of arthritis (25,47,(49)(50)(51)(52). Mass media interventions, a cornerstone of public health, are a promising approach to address some of these gaps. ...
Objective:
Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities.
Methods:
Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models.
Results:
An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7).
Conclusion:
Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.
... Our OAAA group advocates that careful use of vocabulary in conversations surrounding OA symptoms and management can support the importance of weight loss as an effective method to reduce joint pain over the long term. It has been found that terms used by HCPs describing arthritis pathophysiology and rehabilitation were poorly understood and elicited negative emotional responses (51), while empathetic discussions and positive expectations from HCPs have resulted in small to moderate improvements in pain, anxiety, and stress (52). Moreover, it may be beneficial for providers to take a nonpersonal, generic approach so that patients are receptive to the information and do not feel blamed for their arthritis or disease state. ...
Background
For persons with osteoarthritis (OA), nutrition education may facilitate weight and OA symptom management.
Objective
The primary aim of this study was to determine preferred OA-related nutritional and weight management topics and their preferred delivery modality. The secondary aim was to determine if there is a disconnect between what patients want to know about nutrition and OA management, and what information healthcare professionals (HCPs) are providing to patients.
Methods
The Osteoarthritis Action Alliance surveyed individuals with OA to identify their preferences, categorized in four domains: 1) Strategies for weight management/healthy lifestyle; 2) Vitamins/minerals/other supplements; 3) Foods/nutrients that may reduce inflammation; and 4) Diets for weight loss. HCPs were provided these domains and asked which topics they discussed with patients with OA. Both groups were asked to select currently utilized or preferred formats of nutritional resources.
Results
Survey responses from 338 individuals with OA and 104 HCPs were included. Highest preference rankings in each domain were: 1) foods that make OA symptoms worse (65%), foods/nutrients to reduce inflammation (57%), and healthy weight loss (42%); 2) glucosamine (53%), vitamin D (49%), and omega-3 fatty acids (45%); 3) spices/herbs (65%), fruits/vegetables (58%), and nuts (40%); and 4) Mediterranean diet (21%), low-carbohydrate diet (18%) and fasting/intermittent fasting (15%). There was greater than 20% discrepancy between OA person-reported interests and HCP-reported discussions on: weight loss strategies, general information on vitamins/minerals, special dietary considerations for other conditions, mindful eating, controlling caloric intake or portion size, and what foods worsen OA symptoms. Most respondents preferred to receive nutrition information in a passive format and did not want information from social media messaging.
Conclusions
There is disparity between nutrition education content preferred by individuals with OA (which often lacks empirical support) and evidence-based topics being discussed by HCPs. HCPs must communicate evidence-based management of joint health and OA symptoms in patient-preferred formats.
... Building health literacy can increase autonomy and personal empowerment, but this requires interactive communication between patients and health professionals, as well as skills to critically analyze and value different types of information (Nutbeam, 2000). Arthritis terminology might represent a particular challenge in communications between health professionals and their patients with different levels of familiarity with and comprehension of the phrases and words used, and it is important to also understand the emotional impact of such phrases and words (Barker, Reid, and Minns Lowe, 2014). Individually tailored communication might not yet be part of physiotherapy practice in hierarchical societies such as India, where neither patients nor physiotherapists might be used to sharing information based on patients' perspectives on their disease and its management. ...
Background
Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world.
Objective
The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India.
Design and Method
Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India.
Results
Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients’ approaches to OA. The categories were further elaborated on in seven subcategories.
Conclusion
Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists’ implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients.
... 67 Similarly, the detrimental impact of pathoanatomical diagnostic labels and threatening language used to explain pain has been criticized for the resultant negative emotional impact caused to those with shoulder pain 6 as well other conditions such as OA. 68 Despite this, individuals with shoulder pain, as well as those with CLBP, 24,61 knee pain, 58 and knee OA, 59 continue to hold such information in high regard. ...
Objective
The objective of this study was to review and synthesize qualitative research studies exploring the experiences of individuals living with shoulder pain to enhance understanding of the experiences of these individuals as well as facilitate health care developments.
Methods
A meta-ethnographic approach was adopted to review and synthesize eligible published qualitative research studies. The findings from each included study were translated into one another using the Noblit and Hares 7-stage process. A systematic search of 11 electronic databases was conducted in March 2020. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) appraisal tool.
Results
Nineteen studies were included in the meta-synthesis. Included articles explored the lived experiences as well as treatment-related experiences of participants. All of the included articles were deemed to be of high methodological quality. Three themes were identified: (1) negative emotional, social, and activity impact (“It has been a big upheaval”), (2) developing an understanding (“Why is it hurting so much?”), and (3) exercise (“Am I going to go through a lot of pain in moving it…?”). Across the included studies, the severe emotional and physical impact of shoulder pain was a core finding. Many people sought a “permanent” solution involving surgery. Openness to other treatment options was influenced by factors including understanding of pain, prior experiences, and treatment expectations.
Conclusion
These findings deepen understanding of the impact of shoulder pain on peoples’ lives and provide novel insight into the experience of treatment. Enhanced awareness of people’s experiences of shoulder pain and treatment is crucial for clinicians when planning and implementing evidence-based recommendation.
Impact
To the knowledge of the authors, this is the first qualitative evidence synthesis to explore the treatment-related experiences of individuals with shoulder pain. Shoulder surgery was considered by many as the only means to achieve a more permeant resolution of symptoms.
Lay Summary
Shoulder pain causes emotional and physical turmoil that can permeate every facet of life. People’s understanding of their shoulder pain appears to be deeply rooted in a biomechanical view of pain, which influences their expectations relating to diagnosis and treatment.
... 52 53 An explanation for the perception of 'damage' for people with knee osteoarthritis is likely to have been influenced by the results of imaging as well as the messages people receive from their health professionals. 54 This highlights the importance that health professionals not only focus on reducing joint-related pain and improving function, but to also include strategies to dispel patient misconceptions about knee osteoarthritis. 55 Strategies may include providing education that osteoarthritis is not a 'wear and tear' disease, that it does not necessarily worsen with ageing and that people can remain healthy and active with osteoarthritis. ...
... Unhelpful descriptions of osteoarthritis as 'bone-on-bone' or 'wearand-tear' in this study are consistent with other qualitative research involving patients and medical professionals [38,39]. This language (used by both patients and medical professionals) to describe osteoarthritis may negatively impact people's beliefs [40], create concerns about joint damage, and subsequently reduce physical activity and drive beliefs that surgery is the only treatment option [41]. Importantly, these misinformed beliefs may also create barriers for referrals to, and participation in guideline-based non-surgical care such as exercise-therapy. ...
... Much of the work in the field of understanding jargon usage has either focused on controlled settings where scenarios with standardized patients were recorded and transcribed [1-3, 13], or has relied on identifying discrepancies of perceived understanding of common medical phrases between providers and patients through surveys [4,7,9,[14][15][16]. In a controlled environment, Farrell et al. showed that providers were able to improve their jargon usage in recorded standardized encounters when presented with a jargon scorecard [17]. ...
... I just feel that sometimes doctors go in and they're using all these words and stuff. No. Tell me layman's terms, because I'm not dumb, but something like that I don't really understand."[101][24,[29][30][31]34,[41][42][43]46,48,50,57,65,66,68,72,76,80,83,86,91,92,95,98,[101][102][103][104][105][106][107][108][109]Enabling shared decision-making"I know what each one of those pills are, what they're for. ...
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
... 52 53 An explanation for the perception of 'damage' for people with knee osteoarthritis is likely to have been influenced by the results of imaging as well as the messages people receive from their health professionals. 54 This highlights the importance that health professionals not only focus on reducing joint-related pain and improving function, but to also include strategies to dispel patient misconceptions about knee osteoarthritis. 55 Strategies may include providing education that osteoarthritis is not a 'wear and tear' disease, that it does not necessarily worsen with ageing and that people can remain healthy and active with osteoarthritis. ...
Objectives
Systematically review the qualitative literature on living with knee osteoarthritis from patient and carer perspectives.
Design
Systematic review of qualitative studies. Five electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, SPORTDiscus) were searched from inception until October 2018. Data were synthesised using thematic and content analysis.
Participants
Studies exploring the experiences of people living with knee osteoarthritis, and their carers were included. Studies exploring experiences of patients having participated in specific interventions, including surgery, or their attitudes about the decision to proceed to knee replacement were excluded.
Results
Twenty-six articles reporting data from 21 studies about the patient (n=665) and carer (n=28) experience of living with knee osteoarthritis were included. Seven themes emerged: (i) Perceived causes of knee osteoarthritis are multifactorial and lead to structural damage to the knee and deterioration over time (n=13 studies), (ii) Pain and how to manage it predominates the lived experience (n=19 studies), (iii) Knee osteoarthritis impacts activity and participation (n=16 studies), (iv) Knee osteoarthritis has a social impact (n=10 studies), (v) Knee osteoarthritis has an emotional impact (n=13 studies), (vi) Interactions with health professionals can be positive or negative (n=11 studies), (vii) Knee osteoarthritis leads to life adjustments (n=14 studies). A single study reporting the perspectives of carers reported similar themes. Psychosocial impact of knee osteoarthritis emerged as a key factor in the lived experience of people with knee osteoarthritis.
Conclusions
This review highlights the value of considering patient attitudes and experiences including psychosocial factors when planning and implementing management options for people with knee osteoarthritis.
Trial registrationnumber
CRD42018108962
... There is increasing interest in improving clinicianpatient communication in orthopaedics. Previous qualitative work [2] and a recent commentary piece [26] have identified the term "bone on bone" as having a problematic, unintended meaning among patients with OA. In an editorial, Ring et al. [22] considered the way that orthopaedic surgeons talk to patients and how this may influence treatment decision making. ...
Background:
In contrast to best practice guidelines for knee osteoarthritis (OA), findings from several different healthcare settings have identified that nonsurgical treatments are underused and TKA is overused. Empirical evidence and qualitative observations suggest that patients' willingness to accept nonsurgical interventions for knee OA is low. A qualitative investigation of why patients may feel that such interventions are of little value may be an important step toward increasing their use in the treatment of knee OA QUESTIONS/PURPOSES: This qualitative study was embedded in a larger study investigating patient-related factors (beliefs/attitudes toward knee OA and its treatment) and health-system related factors (access, referral pathways) known to influence patients' decisions to seek medical care. In this paper we focus on the patient-related factors with the aim of exploring why patients may feel that nonsurgical interventions are of little value in the treatment of knee OA.
Methods:
A cross-sectional qualitative study was conducted in a single tertiary hospital in Australia. Patients with endstage knee OA on the waiting list for TKA were approached during their preadmission appointment and invited to participate in one-to-one interviews. As prescribed by the qualitative approach, data collection and data analysis were performed in parallel and recruitment continued until the authors agreed that the themes identified would not change through interviews with subsequent participants, at which point, recruitment stopped. Thirty-seven patients were approached and 27 participated. Participants were 48% female; mean age was 67 years. Participants' beliefs about knee OA and its treatment were identified in the interview transcripts. Beliefs were grouped into five belief dimensions: identity beliefs (what knee OA is), causal beliefs (what causes knee OA), consequence beliefs (what the consequences of knee OA are), timeline beliefs (how long knee OA lasts) and treatment beliefs (how knee OA can be controlled).
Results:
All participants believed that their knee OA was "bone on bone" (identity beliefs) and most (> 14 participants) believed it was caused by "wear and tear" (causal beliefs). Most (> 14 participants) believed that loading the knee could further damage their "vulnerable" joint (consequence beliefs) and all believed that their pain would deteriorate over time (timeline beliefs). Many (>20 participants) believed that physiotherapy and exercise interventions would increase pain and could not replace lost knee cartilage. They preferred experimental and surgical treatments which they believed would replace lost cartilage and cure their knee pain (treatment beliefs).
Conclusions:
Common misconceptions about knee OA appear to influence patients' acceptance of nonsurgical, evidence-based treatments such as exercise and weight loss. Once the participants in this study had been "diagnosed" with "bone-on-bone" changes, many disregarded exercise-based interventions which they believed would damage their joint, in favor of alternative and experimental treatments, which they believed would regenerate lost knee cartilage. Future research involving larger, more representative samples are needed to understand how widespread these beliefs are and if/how they influence treatment decisions. In the meantime, clinicians seeking to encourage acceptance of nonsurgical interventions may consider exploring and targeting misconceptions that patients hold about the identity, causes, consequences, timeline, and treatment of knee OA.
Level of evidence:
Level II, prognostic study.
... Patients in the current study who attributed their knee problems to the perception of knee damage exemplified this. An explanation for the negative perception of their knee joint was likely to have been influenced by the results of imaging and what they had heard from health professionals [28,29]. Almost all patients (20/21) in the current study had been referred for surgical opinion with an orthopedic surgeon so discussions with the surgeon about future surgery options may have impacted their perceptions of participating in a walking program. ...
Purpose:
To explore the perceptions of people with severe knee osteoarthritis and increased cardiovascular risk about participating in a walking program.
Methods:
Qualitative study using semistructured interviews for people with severe knee osteoarthritis and increased cardiovascular risk who participated in a 12-week walking program. Interviews were audiotaped, transcribed verbatim, member-checked, coded and themes developed using thematic analysis. Findings were triangulated with quantitative data including pain, function and cardiovascular risk factors from previously reported data.
Results:
Twenty-one participants were interviewed after the completion of the walking program. The main theme identified was the preoccupation with the knee including pain, damage and the view that surgery was required. Three subthemes to emerge were (i) the perception of functional, cardiovascular and psychosocial benefits with the walking program; (ii) that supervision, monitoring and commitment were important enablers; and (iii) external factors such as ill-health, weather and the environment were key barriers. The perceived functional and cardiovascular benefits converged with results from quantitative data.
Conclusions:
Even when patients with severe osteoarthritis of the knee report other benefits from participating in a walking program, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. Implications for Rehabilitation Patients with severe osteoarthritis of the knee and moderate cardiovascular risk reported functional, cardiovascular and psychosocial benefits from participating in a walking program. Despite patients reporting functional, cardiovascular and psychosocial benefits, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. The core theme highlights the challenges in promoting physical activity for patients with severe knee osteoarthritis.
... A review of studies of emotional and cognitive care found that healthcare professionals that reassured their patients and used a warm and inviting attitude achieved better health outcomes (2). Studies of health literacy in British patients with arthritis found that the term "selfmanagement" triggered a negative emotional response (8). A study of companions of 100 patients presenting to a hand clinic identified that terms such as "pain" had a more negative emotional impact than the alternatives "discomfort" and "ache" (4). ...
Background:
Given the strong influence of thoughts, emotions, and behaviors on musculoskeletal symptoms and limitations it's important that both scientific and lay writing use the most positive, hopeful, and adaptive words and concepts consistent with medical evidence. The use of words that might reinforce misconceptions about preference-sensitive conditions (particularly those associated with age) could increase symptoms and limitations and might also distract patients from the treatment preferences they would select when informed and at ease.
Methods:
We reviewed 100 consecutive papers published in 2014 and 2015 in 6 orthopedic surgery scientific journals. We counted the number and proportion of journal articles with questionable use of one or more of the following words: tear, aggressive, required, and fail. For each word, we counted the rate of misuse per journal and the number of specific terms misused per article per journal.
Results:
Eighty percent of all orthopedic scientific articles reviewed had questionable use of at least one term. Tear was most questionably used with respect to rotator cuff pathology. The words fail and require were the most common questionably used terms overall.
Conclusion:
The use of questionable words and concepts is common in scientific writing in orthopedic surgery. It's worth considering whether traditional ways or referring to musculoskeletal illness merit rephrasing.
... However, lay people often do not fully comprehend medical information provided due to medical jargon being used by their physicians when talking to them [6]. Furthermore, medical jargon can be perceived as having negative connotations or may be understood in an unintended way by lay people [7]. Nevertheless, physicians tend to overestimate the clarity of their communication when talking with patients [8] . ...
Background:
Patient-physician communication should be based on plain and simple language. Despite communication skill trainings in undergraduate medical curricula medical students and physicians are often still not aware of using medical jargon when communicating with patients. The aim of this study was to compare linguistic communication skills of undergraduate medical students who voluntarily translate medical documents into plain language with students who do not participate in this voluntary task.
Methods:
Fifty-nine undergraduate medical students participated in this study. Twenty-nine participants were actively involved in voluntarily translating medical documents for real patients into plain language on the online-platform https://washabich.de (WHI group) and 30 participants were not (non-WHI group). The assessment resembled a virtual consultation hour, where participants were connected via skype to six simulated patients (SPs). The SPs assessed participants' communication skills. All conversations were transcribed and assessed for communication skills and medical correctness by a blinded expert. All participants completed a self-assessment questionnaire on their communication skills.
Results:
Across all raters, the WHI group was assessed significantly (p = .007) better than the non-WHI group regarding the use of plain language. The blinded expert assessed the WHI group significantly (p = .018) better regarding the use of stylistic devices of communication. The SPs would choose participants from the WHI group significantly (p = .041) more frequently as their personal physician. No significant differences between the two groups were observed with respect to the medical correctness of the consultations.
Conclusion:
Written translation of medical documents is associated with significantly more frequent use of plain language in simulated physician-patient encounters. Similar extracurricular exercises might be a useful tool for medical students to enhance their communication skills with respect to using plain language in physician-patient communication.
... Or does familiarity with medical terms not imply patients understand them? 23 Do patients even require us to use more medical terms? The latter is unlikely given the results of previous research. ...
Parents of children with a cleft lip and/or palate (CL/P) and patients with CL/P actively search for online information about CL/P. The quality of this information has not been sufficiently evaluated. The aim of this study was to define quality criteria for online information about CL/P and assess the quality of frequently accessed websites. Patients, parents, and professionals were equally involved in all stages of this study. A literature review was performed to obtain known quality criteria for online information. These criteria were prioritized by patients, parents, and professionals. The most important criteria were used to rate the quality of four websites on CL/P. Forty-two quality items were extracted from the literature. Patients, parents, and professionals agreed on the importance of 16 of these items. New groups of patients, parents, and professionals assessed four websites on CL/P. Although the groups were like-minded in their overall assessment of the quality of the websites, distinct differences emerged between the groups in relation to certain items. This study shows the importance of patient participation in healthcare research, as well as a feasible approach to do so. Involving patients in composing online health information will set different priorities, which is necessary in establishing high quality information.
... For test results with potential psychological effects, a section on coping-related strategies could also be included [115,118]. The primary challenge will be to ensure that letters are written in a language understandable to the patient [119,120], with limited use of medical jargon or concepts [121,122]. This approach is being used to communicate pharmacogenetic test results to patients in a study at St Jude Children's Research Hospital; a letter communicating the child's test results is sent to parents along with an information fact sheet [123], and the patient's specific findings and recommendations are inserted into a letter template using patient-friendly language. ...
With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients' health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.
OBJECTIVE: Compare the effects of osteoarthritis information, with or without pathoanatomical content, on people's beliefs about managing osteoarthritis. DESIGN: Online randomised controlled trial involving 556 participants METHODS: Participants considered a hypothetical scenario where their doctor informed them that they had knee osteoarthritis. Participants were randomised to: a control condition, where they received currently-available osteoarthritis information with pathoanatomical content, or an experimental condition, where they received the same osteoarthritis information but without pathoanatomical content. Primary outcomes were participants' beliefs about the need for x-ray to confirm diagnosis and joint replacement surgery in the future. RESULTS: There were no differences in primary outcomes (x-ray: mean between-group difference -0.3 units [95% confidence interval: -0.9, 0.4]; surgery: -0.2 [-0.7, 0.2] on an 11-point numeric rating scale [NRS]). Participants in the experimental group had lower perceptions that exercise would damage the knee (-0.4 [-0.8, 0.0] on 11-point NRS) and better osteoarthritis knowledge (0.9 [0.0, 1.9] on scale ranging 11-55). Among those without tertiary education, participants in the experimental group had lower perceptions that x-ray was necessary than control (-0.8 [-1.5, -0.1]). Among those who had never sought care for knee pain, participants in the experimental group had lower perceptions about need for surgery (-0.7 [-1.2, -0.2]). CONCLUSIONS: Removing pathoanatomical content may not change beliefs about imaging and surgery, but may lead to lower perceptions that exercise is damaging and improve osteoarthritis knowledge. However, effects were small and of unclear clinical relevance. Tertiary education or a history of care-seeking for knee pain may moderate effects on primary outcomes.
Importance
Despite acknowledging that medical jargon should be avoided, health care practitioners frequently use it when communicating with patients.
Objective
To characterize the understanding of common medical jargon terms by surveying a cross section of the general public and studying phrases that have established meanings in regular usage but different meanings in a medical context (eg, negative and positive test results).
Design, Setting, and Participants
In this cross-sectional study, participants indicated their understanding of phrases that may have different meanings in medicine than in colloquial English via a mix of short answer and multiple choice questions. Several questions included paired phrases to assess for differences in understanding with or without jargon. Volunteers were recruited at the 2021 Minnesota State Fair near St Paul, Minnesota. An electronic survey was given to a volunteer sample of 215 adults (>18 years) who did not work or train to work in the medical field and spoke and read English.
Exposures
Completing a written or verbal survey.
Main Outcomes and Measures
The main outcome was an accurate understanding of the medical terminology. Free-text responses were coded by 2 researchers for comprehension. Secondary outcomes looked for associations between volunteer demographics and understanding.
Results
The 215 respondents (135 [63%] female; mean [SD] age, 42 [17] years) demonstrated a varied ability to interpret medical jargon phrases. For example, most participants (207 [96%]) knew that negative cancer screening results meant they did not have cancer, but fewer participants (143 [79%]) knew that the phrase “your tumor is progressing” was bad news, or that positive lymph nodes meant the cancer had spread (170 [67%]). While most (171 [80%]) recognized that an unremarkable chest radiography was good news, only 44 participants (21%) correctly understood that a clinician saying their radiography was impressive was generally bad news. In each of the paired phrases comparing jargon vs nonjargon approaches, the nonjargon phrase was understood significantly better ( P < .001).
Conclusions and Relevance
These findings suggest that several common phrases are misunderstood when used in a medical setting, with the interpreted meaning frequently the exact opposite of what is intended.
Objective
To explore the acceptability, barriers and enablers of NICE guidelines for osteoarthritis in the Scottish primary care setting using the Joint Implementation of Guidelines for Osteoarthritis in Western Europe (JIGSAW-E) model and investigate the role of Advanced Physiotherapy Practitioners (APPs) in providing evidence-based care.
Design
A qualitative case study comprised of semi-structured interviews followed by a workshop with participants.
Setting
10 Scottish primary care practices.
Participants
Six general practitioners (GPs) and eight APPs were interviewed. Twenty-three practitioners attended the workshop including 22 physiotherapists and one GP.
Results
While both GPs and APPs recognised the need to improve and standardise osteoarthritis care delivery, this study found that APPs were better situated to implement the evidence-based model. Barriers to implementation included lack of time for training, limited appointment time for GPs to consult and discuss medication use with patients, limitation of disease specific guidelines for patients with complex multimorbidity, and system-based barriers such as electronic data collection and high staff turnover. The key enabler was practitioners’ motivation to provide optimal, standardised quality care for osteoarthritis. To increase acceptance, ownership and usability for both practitioners and patients, the JIGSAW-E model materials required adaptation to the local context.
Conclusion
This study provides evidence that the JIGSAW-E model is acceptable in Scottish primary care. Furthermore, the evolving roles of GPs and APPs within multidisciplinary primary care teams provides a platform to implement the JIGSAW model, where APPs are well placed to provide leadership and training in the delivery of evidence-based care for osteoarthritis.
Objective
To explore primary care practitioners’ (PCPs) and patients’ priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care.
Methods
We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptoms. Patient and PCP perceptions were analysed separately then inter-related using a ‘line of argument’ synthesis.
Results
Twenty-six studies reporting qualitative data from 557 patients and 199 PCPs were synthesised. Our findings suggest that therapeutic interactions for OA can be based on discordant priorities and concerns; some patients perceive that PCPs hold negative attitudes about OA and feel their concerns about impact are not appreciated; some PCPs feel patients have misconceptions about prognosis, and hold pessimistic views about outcomes; and both tend to de-prioritise OA within consultations.
Conclusion
Greater working in partnership could build mutual trust, facilitate tailored provision of information, and foster a shared understanding of OA upon which to build realistic goals for management.
Practice implications
Developing a better shared understanding of OA has the potential to improve the quality of healthcare interactions for both patients and PCPs. The significant impact of OA on everyday life means it should be given higher priority in primary care consultations.
Background
Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach.
Aim
To explore patients’ perspectives on clinician communication of empathy and optimism in primary care OA consultations.
Design & setting
Vignette study with qualitative semi-structured interviews.
Setting
Purposefully sampled patients (n=33) aged 45+ with hip/knee OA from Wessex GP practices.
Method
Fifteen participants watched two filmed OA consultations with a GP, and eighteen participants read two case vignettes. In both formats, one GP depicted an empathic optimistic approach and one GP had a ‘neutral’ approach. Semi-structured interviews were conducted with all participants and analysed using thematic analysis.
Results
Patients recognised that empathic communication enhanced interactions, helping to engender a sense of trust in their clinician. They felt it was acceptable for GPs to convey optimism only if it was realistic, personalised and embedded within an empathic consultation. Discussing patients’ experiences and views with them, and conveying an accurate understanding of these experiences improves the credibility of optimistic messages.
Conclusion
Patients value communication with empathy and optimism, but it requires a fine balance to ensure messages remain realistic and trustworthy. Increased use of a realistic optimistic approach within an empathic consultation could enhance consultations for OA and other chronic conditions, and improve patient outcomes. Digital training to help GPs implement these findings is being developed.
Objective
To explore barriers and enablers for referral to, and participation in, a contemporary guideline-based osteoarthritis management program – Good Life with osteoArthritis in Denmark (GLA:D® Australia).
Design
A qualitative design was used, involving semi-structured interviews with patients with osteoarthritis and medical professionals. Interviews were audiotaped, transcribed verbatim, coded and thematically analysed. Barrier and enabler themes were mapped to the theoretical domains framework and used to inform the development of recommendations for improving uptake of guideline-based osteoarthritis management programs.
Results
Twenty patients with hip and/or knee osteoarthritis and 15 medical professionals (5 general practitioners, 4 rheumatologists, 6 orthopaedic surgeons) were included. Across both groups, three themes emerged as barriers (program access; misinformation about osteoarthritis; patient and program factors), one theme emerged as a barrier and enabler (health professional trust, feedback and advice), and two themes emerged as enablers (opportunity to achieve positive outcomes and potentially avoid joint replacement surgery; better program promotion, patient and health professional education, and efficient referral processes).
Conclusions
Optimising uptake of guideline-based osteoarthritis management programs requires improved reimbursement models, and better promotion and educational initiatives for patients and medical professionals. A particular focus of education should include dispelling misinformation about osteoarthritis, and highlighting the safety and value of physiotherapist delivered exercise-therapy.
Background
Outpatient parenteral antimicrobial therapy (OPAT) is widely used in most developed countries, providing considerable opportunities for improved cost savings. However, it is implemented only partially in the UK, using a variety of service models.
Objectives
The aims of this research were to (1) establish the extent of OPAT service models in England and identify their development; (2) evaluate patients’ preferences for different OPAT service delivery models; (3) assess the cost-effectiveness of different OPAT service delivery models; and (4) convene a consensus panel to consider our evidence and make recommendations.
Methods
This mixed-methods study included seven centres providing OPAT using four main service models: (1) hospital outpatient (HO) attendance; (2) specialist nurse (SN) visiting at home; (3) general nurse (GN) visiting at home; and (4) self-administration (SA) or carer administration. Health-care providers were surveyed and interviewed to explore the implementation of OPAT services in England. OPAT patients were interviewed to determine key service attributes to develop a discrete choice experiment (DCE). This was used to perform a quantitative analysis of their preferences and attitudes. Anonymised OPAT case data were used to model cost-effectiveness with both Markov and simulation modelling methods. An expert panel reviewed the evidence and made recommendations for future service provision and further research.
Results
The systematic review revealed limited robust literature but suggested that HO is least effective and SN is most effective. Qualitative study participants felt that different models of care were suited to different types of patient and they also identified key service attributes. The DCE indicated that type of service was the most important factor, with SN being strongly preferred to HO and SA. Preferences were influenced by attitudes to health care. The results from both Markov and simulation models suggest that a SN model is the optimal service for short treatment courses (up to 7 days). Net monetary benefit (NMB) values for HO, GN and SN services were £2493, £2547 and £2655, respectively. For longer treatment, SA appears to be optimal, although SNs provide slightly higher benefits at increased cost. NMB values for HO, GN, SN and SA services were £8240, £9550, £10,388 and £10,644, respectively. The simulation model provided useful information for planning OPAT services. The expert panel requested more guidance for service providers and commissioners. Overall, they agreed that mixed service models were preferable.
Limitations
Recruitment to the qualitative study was suboptimal in the very elderly and ethnic minorities, so the preferences of patients from these groups might not be represented. The study recruited from Yorkshire, so the findings may not be applicable nationally.
Conclusions
The quantitative preference analysis and economic modelling favoured a SN model, although there are differences between sociodemographic groups. SA provides cost savings for long-term treatment but is not appropriate for all.
Future work
Further research is necessary to replicate our results in other regions and populations and to evaluate mixed service models. The simulation modelling and DCE methods used here may be applicable in other health-care settings.
Funding
The National Institute for Health Research Health Service and Delivery Research programme.
Health literacy (HL) is the extent to which individuals have the capacity to obtain, process, and understand basic health information that is needed to make appropriate health decisions. As adults with inflammatory bowel disease engage in complex health decisions throughout their lives, attention is needed regarding the influence of HL on the lives of people with inflammatory bowel disease. About one-third of adults in the United States have limited HL. Limited HL is a potentially modifiable risk factor that has been associated with barriers to patient-provider communication and worse health outcomes for people with a range of chronic diseases. Gastroenterologists must recognize the role of HL in their practice. Limited HL can affect a patient's ability to understand the purpose of a screening test for colorectal cancer, understand the concept of an asymptomatic yet chronic disease, ask questions in an office visit and engage in shared decision making. Gastroenterologists must approach each patient as potentially having limited HL and use clear communication strategies in all encounters. Currently, there is a lack of training, education, and support for health care providers to meet the needs of patients with limited HL. More research is needed in inflammatory bowel disease to understand the impact of limited health literacy on health outcomes in this population and develop effective systems-based interventions to reduce the health literacy burden on patients.
Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written information for patients about their condition is seen as an important aid to help patients look after themselves. From a discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed and to consider the implications for self-care.
Systematic and repeated readings of six patient information leaflets on osteoarthritis to look for similarities and differences across leaflets, contradictions within leaflets and the resources called on to make claims about the nature of OA and its management.
Biomedical discourse of OA as a joint disease dominated. Only one leaflet included an illness discourse albeit limited, and was also the only one to feature patient experiences of living with OA. The leaflets had different views on the causes of OA including the role of lifestyle and ageing. Most emphasised patient responsibility for preventing the progression of OA. Advice about changing behaviour such as diet and exercise was not grounded in lived experience. There were inconsistent messages about using painkillers, exercise and the need to involve professionals when making changes to lifestyle.
The nature of the discourse impacted on how OA and the respective roles of patients and professionals were depicted. Limited discourse on illness meant that the complexity of living with OA and its consequences was underestimated. Written information needs to shift from joint biology to helping patients live with osteoarthritis. Written information should incorporate patient experience and value it alongside biomedical knowledge.
"Arthritis" is a common musculoskeletal condition but the knowledge of what type of arthritis people have, may be limited but may have changed over time in response to campaigns, increased awareness and improved health literacy. This paper describes people who did not know what type of arthritis they had, by a range of relevant demographic and socioeconomic variables, and assesses changes over time in the proportion of people who report having arthritis but do not know what type, using representative population surveillance data.
Data were collected using the South Australian Monitoring and Surveillance System (SAMSS), a risk factor surveillance system where each month, a representative random sample of South Australians is selected from the Electronic White Pages, with interviews conducted using computer assisted telephone interviewing (CATI). Data were used for the period January 2006 to December 2008 (n = 16465) for respondents aged 18 years and over.
Overall, the proportion of respondents who did not know what type of arthritis they had, among people aged 18 years and over, for 2006 to 2008 was 6.5% (95% CI 6.1-6.9). When considering only those respondents reporting that they had been told by a doctor that they had arthritis, 30.1% did not know what type of arthritis they had. Multivariate analysis indicated that males, those with have a trade, certificate or diploma or secondary level of education, who spoke a language other than English at home, were widowed and earned $20,001 to $60,000, more than $80,000 or did not state their income were more likely to maintain that they did not know what type of arthritis they had.
Population ageing and an increase in arthritis prevalence in the future will further increase the burden of arthritis. These increases in prevalence are not inevitable, especially if investments are made in public health prevention programs, particularly those addressing cultural and linguistic diversity and differences in socio-economic status and health literacy.
The importance of using a common language when communicating to others about back pain is acknowledged in the literature. There are broadly three areas where difficulties in communication about back pain arise. Firstly, patients seeking information from health care professionals can experience difficulties understanding them and the medical literature; secondly, misunderstandings among health professionals concerning terminology can arise. Thirdly, the lack of standardised definitions for back pain terms can make comparison of research studies problematic. This study aims to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals, lay people who have consulted health care practitioners for back pain and lay people who have not seen a health care professional regarding back pain.
A series of focus groups were used to explore participants' understanding. A purposive sampling approach was used to achieve a sample which included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people. Focus groups were facilitated by an independent professional qualitative researcher. They were audio taped and full transcripts of each focus group underwent line by line analysis, identifying concepts and coded. Constant comparison was used to allow each item to be checked or compared against the rest of the data
Lay participants understood the majority of the terms explored in the group differently to the health professionals. The terms, as understood by the lay participants, can be split into three broad categories. Firstly, terms which were not understood or were misconstrued and which had inadvertent negative connotations or implications. Secondly, terms which were not understood or were misconstrued, but without this leading to negative emotional responses. Thirdly, terms which were understood by lay participants as the health professionals stated they intended them to be understood.
Few of the existing medical terms were understood and accepted by lay participants in the way discussed and expected by health professionals. Misunderstandings, unintended meanings and negative emotional responses to terms were common within the study focus groups.
OBJECTIVE: To compare public perceptions and patient perceptions about back pain and its management with current clinical guidelines. DESIGN: A survey using a quota sampling technique. SETTING: On-the-street in South Derbyshire in the UK. SUBJECTS: 507 members of the general population aged between 20 and 60 years, including a representative subsample of 40% who had experienced back pain in the previous year. SURVEY: To test knowledge and perceptions of back pain and its best management using statements based on The Back Book which was produced in conjunction with the Royal College of General Practitioners and based on best available evidence. In addition expectations of back pain management and outcome were investigated. RESULTS: Forty percent of this sample had experienced back pain during the previous year, more than half of whom had consulted their GP. More than half believed the spine is one of the strongest part of the body, but nearly two thirds incorrectly believed that back pain is often due to a slipped disc or trapped nerve. Two thirds expected a GP to be able to tell them exactly what was wrong with their back, although slightly fewer among those who had consulted. Most expected to have an X-ray, especially if they had consulted. Most recognised that the most important thing a GP can do is offer reassurance and advice. The responses were not related to age, gender or social class. Those who had consulted appeared to have slightly more misconceptions: this could be partly due to people with more severe problems or more misconceptions being more likely to consult, but also suggests either that GPs are still giving inaccurate information or at least failing to correct these misconceptions. CONCLUSIONS: The problem of managing back pain might be reduced by closing the gap between the public's expectations and what is recommended in the guidelines through the promotion of appropriate health education messages. Further professional education of GPs also appears to be needed to update them in the most effective approach to managing back pain.
Alzheimer's disease (AD) is a chronic condition in which inflammation has been shown to contribute to neurodegeneration. Current thinking suggests that deposition of beta-amyloid in the brain promotes inflammation resulting in neuronal damage/death. Alternatively, our data suggest that chronic inflammation observed in late-onset sporadic AD may be stimulated by infection with the obligate, intracellular bacterium, Chlamydia pneumoniae. Our results indicate that C. pneumoniae is found in high frequency in glial cells in areas of neuropathology within the brains of patients with AD. Based on our evidence, nervous system infection with C. pneumoniae should be considered a risk factor for sporadic AD.
Osteoarthritis (OA) of the knee is common and disabling. Exercise is effective in reducing pain and disability, but long-term adherence to exercise regimens is disappointing, and motivation to exercise in those with OA knee is poorly understood.
To examine the views of primary care patients with OA knee towards exercise, explore factors that determine the acceptability and motivation to exercise, and to identify barriers that limit its use.
Semi-structured interviews were conducted with 22 primary care patients with OA knee, six of whom also participated in a focus group for triangulation. Transcripts were coded into categories and themes to develop a conceptual framework and typology of exercise behaviour.
Exercise behaviour depended upon physical capacity to exercise; exercise beliefs and other factors such as enjoyment, social support, priority setting and context. Four types of patients were identified: 'long-term sedentary' who had never exercised; 'long-term active' who continued to exercise; 'exercise retired' who used to exercise, but had stopped because of their symptoms, and because they believed that exercise was damaging their joints; and 'exercise converted' who recently started to exercise, and preferred a gym because of the supervision and social support they received there.
Several physical, cognitive and contextual factors, and a typology of exercise behaviour were identified that could be addressed in primary care consultations. The importance of gyms and GP referral schemes for people who are exercising for the first time, and the high level of patient satisfaction associated with these were highlighted.
Objective
To compare public perceptions and patient perceptions about back pain and its management with current clinical guidelines.DesignA survey using a quota sampling technique.SettingOn-the-street in South Derbyshire in the UK.Subjects507 members of the general population aged between 20 and 60 years, including a representative subsample of 40% who had experienced back pain in the previous year.SurveyTo test knowledge and perceptions of back pain and its best management using statements based on The Back Book which was produced in conjunction with the Royal College of General Practitioners and based on best available evidence. In addition expectations of back pain management and outcome were investigated.ResultsForty percent of this sample had experienced back pain during the previous year, more than half of whom had consulted their GP. More than half believed the spine is one of the strongest part of the body, but nearly two thirds incorrectly believed that back pain is often due to a slipped disc or trapped nerve. Two thirds expected a GP to be able to tell them exactly what was wrong with their back, although slightly fewer among those who had consulted. Most expected to have an X-ray, especially if they had consulted. Most recognised that the most important thing a GP can do is offer reassurance and advice. The responses were not related to age, gender or social class. Those who had consulted appeared to have slightly more misconceptions: this could be partly due to people with more severe problems or more misconceptions being more likely to consult, but also suggests either that GPs are still giving inaccurate information or at least failing to correct these misconceptions.Conclusions
The problem of managing back pain might be reduced by closing the gap between the public’s expectations and what is recommended in the guidelines through the promotion of appropriate health education messages. Further professional education of GPs also appears to be needed to update them in the most effective approach to managing back pain.
The use of the word degeneration, particularly in the compensation arena, is not recommended. It is imprecise and is interpreted in different ways by radiologists, clinicians and insurers. Insurers use the word to conclude that any so called degenerative changes mean that there is age causation so that compensation can be denied. These changes can be caused by single or multiple injuries continuing heavy work and other causes. Each risk factor should be carefully assessed in each case.
Patients' affect and expectancies can set off placebo effects and thus impact patients' health. We assessed the relative effects of physicians' affect-oriented communication style and raising expectations on patients' affective state and outcome expectancies.
Thirty healthy women presented severe menstrual pain in a scripted consultation with a general practitioner (GP). In a 2x2 randomized controlled trial, the GP communicated in a warm, empathic or cold, formal way and raised positive or uncertain expectations. Effects on subjects' state anxiety, affective state and outcome expectancies were assessed.
Only warm, empathic communication combined with positive expectations led to a significant and relevant decrease in state anxiety. Subjects' positive and negative affects were influenced by GPs affect-oriented communication style. Negative affect and outcome expectancies are influenced by GP suggestions about outcomes.
Manipulations in physicians' affect-oriented and expectancy-related communication can have a large impact on patients' affective state and outcome expectations. A combination of a warm, empathic communication style and raising positive expectations resulted in optimal subject outcomes.
Physicians should take into account that communicating in warm, empathic way combined with raising positive expectations seems to lead to the most favorable effects on patients' state anxiety and outcome expectancies.
To evaluate the effectiveness of a community-based aquatic exercise program for improved quality of life among persons with osteoarthritis.
Two hundred forty-nine adults with osteoarthritis were enrolled in a 20-wk randomized controlled trial of a preexisting community-based aquatic exercise program versus control. Intervention group participants (n = 125) were asked to attend at least two aquatic exercise sessions per week. Control group participants (n = 124) were asked to maintain their usual activity levels. Demographics were collected at baseline, and patient-reported outcomes were collected at baseline and after 10 and 20 wk. Depressive symptoms, self-efficacy for pain and symptom control, physical impairment, and activity limitation were tested as potential mediators of the relationship between aquatic exercise and perceived quality of life (PQOL). Body mass index (BMI), ethnicity, self-rated health, and comorbidity were tested as possible moderators.
Aquatic exercise had a positive impact on PQOL scores (P < 0.01). This effect was moderated by BMI (P < 0.05) such that benefits were observed among obese participants (BMI >or= 30), but not among normal weight or overweight participants. None of the tested variables were found to mediate the relationship between aquatic exercise and PQOL scores.
Given the availability of existing community aquatics programs, aquatic exercise offers a therapeutic and pragmatic option to promote quality of life among individuals who are living with both obesity and osteoarthritis. Future investigation is needed to replicate these findings and develop strategies to increase long-term participation in aquatics programs.
The purpose of this study was to describe the types of pain information described by older adults with chronic osteoarthritis pain. Pain descriptions were obtained from older adults' who participated in a post-test-only double-blind study testing how the phrasing of health care practitioners' pain questions affected the amount of communicated pain information. The 207 community-dwelling older adults were randomized to respond to either the open-ended or the closed-ended pain question. They viewed and orally responded to a computer-displayed videotape of a practitioner asking them the respective pain question. All of them then viewed and responded to the general follow-up questions, "What else can you tell me?" and lastly, "What else can you tell me about your pain, aches, soreness or discomfort?" Audiotaped responses were transcribed and their content analyzed by trained independent raters using 16 a priori criteria from the American Pain Society's Guidelines for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Older adults described important but limited types of information primarily about pain location, timing, and intensity. Pain treatment information was elicited after repeated questioning. Therefore, practitioners need to follow up older adults' initial pain descriptions with pain questions that promote a more complete pain management discussion. Routine use of a multidimensional pain assessment instrument that measures information such as functional interference, current pain treatments, treatment effects, and side effects would be one way of ensuring a more complete pain management discussion with older adults.
Using the Italian version of the McGill Pain Questionnaire (MGPQ), the language of pain was assessed in three chronic rheumatic diseases, namely Fibromyalgia syndrome (FS), Rheumatoid Arthritis (RA) and Osteoarthritis (OA). The Pain Rating Index (PRI) of the MGPQ clearly allowed OA to be distinguished from RA and FS. Words of the affective and sensory subclasses were chosen more frequently in FS, RA and OA respectively. By analyzing words chosen by at least 33% of the patients, a thermal sensory descriptor arose in FS. Data from this study suggest that the MGPQ-PRI might be useful for the assessment of fibromyalgic pain in a clinical setting and during follow-up of the disease.
Eighty patients with a diagnosis of either rheumatoid arthritis, localised osteoarthritis, or generalised osteoarthritis were asked to describe their pain by selecting words from a standardised list of pain descriptors. Words on this list were taken from the sensory class of pain descriptors found in the McGill pain questionnaire. Discriminant analysis was used to identify distinctive characteristics for each of these pain syndromes. On the basis of this analysis verbal responses for each patient were classified into one of the three diagnostic categories. Correct classification occurred in 65% of cases. An estimate of the technique's performance in prospective validation was derived by a split sample approach.
Uncertainty is the rule rather than the exception when it comes to the underlying causes of 'common' or 'non-specific' low back pain. It may be called many names, depending on whether the diagnostic term is descriptive, anatomopathological or physiopathological. Classifications have been devised, including various criteria: symptoms and signs, duration, treatment, consequences of low back pain on the patients' daily life, etc. Because back pain frequently runs a recurrent course, functional and pain outcomes need to be considered separately: chronic disability and chronic pain may not be parallel. Thus, pain duration (e.g. acute, transient, recurrent, chronic) is only one element in the definition of chronicity. These difficulties in defining and classifying non-specific low back pain may lead to communication problems among health professionals as well as between patients and health professionals. These difficulties raise questions such as: what kind of diagnostic term should we use to avoid dramatization of non-specific low back pain? how can we improve the definition of long-term low back pain? and how can we assure and reassure the patient that this condition is benign in the majority of the population?
Although the advisability of combining qualitative and quantitative approaches has been questioned on the grounds of incompatibility of epistemological assumptions that underpin the two paradigms, mixing methods within the qualitative paradigm has been viewed as a more straightforward enterprise. This article challenges this view, highlighting the existence of several qualitative traditions, each with its own distinctive set of assumptions about what constitutes appropriate research questions; theoretical frameworks; research settings; relationships with those whom we study; techniques for eliciting data; form and content of data; and approaches to analyzing, presenting, and disseminating data. Multimethod qualitative approaches can be seen to occupy a contested domain. Analytical rigor would be strengthened by acknowledging and addressing the potentially contradictory assumptions on which one draws when seeking to combine qualitative methods. As qualitative researchers, it is incumbent on us to pay attention to context--not just in terms of the data collected but in terms of our own methodological positions.
Throughout history, doctor-patient relationships have been acknowledged as having an important therapeutic effect, irrespective of any prescribed drug or treatment. We did a systematic review to determine whether there was any empirical evidence to support this theory.
A comprehensive search strategy was developed to include 11 medical, psychological, and sociological electronic databases. The quality of eligible trials was objectively assessed by two reviewers, and the type of non-treatment care given in each trial was categorised as cognitive or emotional. Cognitive care aims to influence patients' expectations about the illness or the treatment, whereas emotional care refers to the style of the consultation (eg, warm, empathic), and aims to reduce negative feelings such as anxiety and fear.
We identified 25 eligible randomised controlled trials. 19 examined the effects of influencing patients' expectations about treatment, half of which found significant effects. None of the studies examined the effects of emotional care alone, but four trials assessed a combination of both cognitive and emotional care. Three of these studies showed that enhancing patients' expectations through positive information about the treatment or the illness, while providing support or reassurance, significantly influenced health outcomes.
There is much inconsistency regarding emotional and cognitive care, although one relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.
This qualitative study aims to investigate which factors are possibly associated with the onset of generalized osteoarthritis (OA) in older women.
The study population was recruited from participants of a group course, "Coping With Osteoarthritis of the Hip or Knee." Twenty-three women with generalized OA were identified, 20 of whom participated in a semistructured interview at home. All data were self-reported by the subjects.
Hereditary factors were present in 17 women. Metabolic factors (such as impairments in carbohydrate and lipid metabolism, diabetes, etc.) were not prevalent. Twelve women thought that certain diets influenced their pain symptoms. Five women spontaneously mentioned their health status during the Second World War as a cause of their OA. Four considered too much stress as being a cause, and in 13 women symptoms started after a period of stressful life events or depression.
According to the respondents, depression, stress, and diets are associated with the onset and worsening of their generalized OA. Heredity and a low health status at a vulnerable age may also be important. These findings could generate new hypotheses that can be tested in future quantitative studies.
To investigate how people perceive some of the words and phrases commonly used in prenatal diagnosis counselling.
A questionnaire containing 25 questions with forced choice answers was administered in the form of a lecture. Respondents were asked to report how worrying they would find different ways of being told about hypothetical anomalies or risks of anomalies in their baby. 581 questionnaires were completed by 372 health professionals and 209 members of the public. The sample was obtained opportunistically. The exact number of non-responders is not known but is estimated to be less than 5%.
Respondents reported being particularly worried by the use of genetic jargon and use of the following words: rare, abnormal, syndrome, disorder, anomaly and high risk. They found risk expressed as 1 in X more worrying than when it was expressed as a percentage, and they consistently reacted as if they estimated the chance of an undesired outcome occurring to be greater than that of a desired outcome occurring when both events were equally likely.
The choice of words used to describe a condition or to inform someone about the level of risk of an adverse event occurring may significantly affect how the person perceives that condition or risk.
To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.
Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale.
Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided.
Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
This paper is a presentation of the critical reflection on the types of findings obtained from the combination of individual interviews and focus groups, and how such triangulation contributes to knowledge production and synthesis.
Increasingly, qualitative method triangulation is advocated as a strategy to achieve more comprehensive understandings of phenomena. Although ontological and epistemological issues pertaining to triangulation are a topic of debate, more practical discussions are needed on its potential contributions, such as enhanced data richness and depth of inquiry.
Data gathered through individual interviews and focus groups from a study on patterns of cancer information-seeking behaviour are used to exemplify the added-value but also the challenges of relying on methods combination.
The integration of focus group and individual interview data made three main contributions: a productive iterative process whereby an initial model of the phenomenon guided the exploration of individual accounts and successive individual data further enriched the conceptualisation of the phenomenon; identification of the individual and contextual circumstances surrounding the phenomenon, which added to the interpretation of the structure of the phenomenon; and convergence of the central characteristics of the phenomenon across focus groups and individual interviews, which enhanced trustworthiness of findings.
Although the use of triangulation is promising, more work is needed to identify the added-value or various outcomes pertaining to method combination and data integration.
diagnosed Rehabilitation means like getting you back to what you were before, but how can they do that with arthritis? There's no real. . .. hope you can rehabilitate with arthritis Men
- Woman
- C2de
Woman, C2DE, Midlands, diagnosed Rehabilitation means like getting you back to what you were before, but how can they do that with arthritis? There's no real.... hope you can rehabilitate with arthritis Men, ABC1, North East, diagnosed References
Coping with stress among middle-aged and older women and men with arthritis
- Y Iwasaki
- J Butcher
Iwasaki Y, Butcher J. Coping with stress among middle-aged and older women and men with arthritis. Int J Psychosoc Rehabil 2004;8: 179–208.
not diagnosed I thought it was very similar to arthritis. But I don't know. . . I thought rheumatism was like to do with your blood as well Woman, C2DE, Midlands, not diagnosed rheumatism is muscles and arthritis is to do with the bones
- Women
- Abc
Women, ABC1, Midlands, not diagnosed I thought it was very similar to arthritis. But I don't know... I thought rheumatism was like to do with your blood as well Woman, C2DE, Midlands, not diagnosed rheumatism is muscles and arthritis is to do with the bones.
Osteoarthritis the care and management of osteoarthritis in adults. NICE clinical guideline 59
- N I Excellence
Excellence, N.I.f.H.a.C. Osteoarthritis the care and management of osteoarthritis in adults. NICE clinical guideline 59. 2008. Available from: http://www.nice.org.uk/nicemedia/live/11926/39720/ 39720.pdf [last accessed 4 May 2012].
The effect of physician's affect-orientated communication style and raising expectations on analogue patients' anxiety, affect and expectancies
- W Verhuel
- S Sanders
- J Bensing
Available from: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4008765 [last accessed 11
- Department Of Health Guidance
Qualitative inquiry and research design
- J W Creswell