How healthcare professionals' word choice affects patient' perceptions on low back pain
Words can go a long way in patient-physician communication
Chronic low back pain (LBP) is a major issue found prevalently in most populations that continues to plague those who suffer from it with distress and disability, thus making it a an important task for healthcare professionals. In addition to the physical aspects involved with the condition, there are also some psychosocial factors that can influence LBP’s development and progression such as fear-related and negative beliefs. The manner in which a diagnosis is explained to a patient with LBP, particularly in the word choice used by healthcare professionals, may lead to some of these beliefs, which makes it essential to consider what these professionals themselves believe and how they deliver news to patients. There’s a vast amount of terminology available to radiologists, clinicians and others involved in LBP analysis, and it’s important to understand what messages are being transmitted to patients, directly and indirectly, by the terms that are used. Based on these observations, a study was conducted to explore the terminology used by sufferers of chronic LBP to describe their condition and to compare it to the terms used by radiologists, general practitioners and secondary care specialists to determine where and why similarities exist.
Eligible patients given detailed interviews to gauge outlooks
Patients who experienced LBP for more than 12 months and participated in a pain management program were deemed eligible for the study, and of the 210 cases that were reviewed, a total of 80 were eligible and used as the study group. Each patient was interviewed with questions regarding their understanding of the mechanism underlying their back pain, the mechanism of any flares of pain, and their expectations of future outcomes with the condition. After recording these interviews, the case notes for all patients, which consisted of reports and letters from healthcare professionals, with specifics on their condition, were also transcribed. The information gathered here was analyzed further to seek out any themes or similar phrases found between patient responses and letters from physicians that could indicate an impact on patient' outlooks.
Certain terms lead to negative perceptions
Once responses were culled together, it was shown that each of the patient and professional groups preferred different terms when describing LBP, but there were a number of themes that emerged between groups. Though all groups used degenerative terms—ones describing an ongoing deterioration—to describe pain, patients perceived their relevance more negatively than medical professionals. Data showed that patients who used degenerative terms and explained their condition in terms of wear and tear expected a poor overall outcome, scoring lower on their perceived prognosis than others because they believed the terms implied permanence and progression. Many patients also used mechanical terms—ones describing specific occurrences in the body like slipped disc or muscle spasm—to describe pain as well, but these terms were not associated with poor perceptions of their condition. On the whole, it was found that the use of degenerative or mechanical terms by secondary care professionals was associated with usage of the same terms by patients, suggesting that patients clearly derive at least part of their beliefs on pain from their clinicians. Since healthcare professionals interpret radiology reports to their patients, and since it’s proven that their interpretation can impact a patient’s perception, they should use more judgment in determining what terms they use in describing these reports and degenerative terms clearly should be omitted.Healthcare professionals of all levels should therefore pay greater attention to the language they use in delivering news to patients, and perhaps by re-strategizing and using a system more focused on the repair aspect of LBP than the damage itself, patients will have a more positive outlook on their condition and possibly rehabilitate at a better rate.
-Summarized by Greg Gargiulo
-As reported in the October '10 edition of Spine
