Patient-centred care: the cornerstone for high-value musculoskeletal pain management

• Published in: British journal of sports medicine 2020-11, Vol.54 (21), p.1240-1242
• Main Authors: Lin, Ivan, Wiles, Louise, Waller, Rob, Caneiro, JP, Nagree, Yusuf, Straker, Leon, Maher, Chris G, O'Sullivan, Peter P B
• Format: Article
• Language: English
• Subjects: back; Cancer; Communication; Decision making; Editorial; evidence based; Exercise; Humans; knowledge translation; Manipulative therapy; Musculoskeletal Pain - therapy; osteoarthritis; Pain; Pain management; Pain Management - methods; Pathology; Patient satisfaction; Patient-Centered Care; Physical fitness; Professional-Patient Relations; Questionnaires; Surgery
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2019-101918

Patient-centred care is based on effective communication Patient-centred care incorporates each individual’s context, knowledge, needs, values, goals and preferences into shared decision-making about management.4 Achieving this relies on effective communication,4 which elicits the patient’s concerns, within their unique context, leading to a partnership in management. Effective communication is especially important when exploring sensitive psychological, social and lifestyle issues, explaining health information in ways that make sense and do not alarm patients and coaching patients to change their behaviour. Effective communication allows more accurate diagnoses, increases patient satisfaction and knowledge about health issues, and enhances the therapeutic relationship.5 More effective verbal and non-verbal communication helps patients to feel more confident and in control, and reduces pain.6 Patients with MSK pain consistently report that they would like communication to be more encouraging, personalised and involving of them in decision-making.7 8 In general, clinicians are more familiar with communication content (ie, what is communicated) than process (ie, how it is communicated).2 For example, for a patient with shoulder pain, clinicians need to understand how the problem started, the pain features, screen for serious pathology and what management steps they have taken; this is communication content. Evidence supports communication education programmes that use active learning strategies such as role play, reflective feedback and small group discussion.2 Table 1 Examples of applying recommendation 1, patient-centred communication versus ‘tick-box’ communication, for each of the remaining 10 best-care recommendations for musculoskeletal pain Recommendation Tick-box communication Patient-centred communication Communication skills used in a patient-centred approach 2. Radiological imaging is discouraged unless serious pathology is suspected; there has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms, or it is likely to change management.