A study conducted by a professor has revealed that shared decision-making and the effectiveness of healthcare providers in taking patient histories and performing physical exams significantly influence patient satisfaction, trust, and agreement with their doctors regarding spinal pain management.
Chronic pain, which is defined as persistent pain lasting more than three months, can pose diagnosis and treatment challenges. The complexities surrounding chronic pain often lead to heightened patient anxiety and depression, making discussions with healthcare providers difficult, as indicated by various studies.
The recent research involving 200 adults suffering from chronic neck or back pain was spearheaded by Charee Thompson, a communications professor at the University of Illinois Urbana-Champaign. The findings highlighted that effective communication between physicians and patients during initial consultations can help alleviate patients’ uncertainties, including their fears and anxieties, while fostering confidence in managing their conditions.
“Our study demonstrated that both providers and patients who view themselves and each other as skilled communicators can help reduce patient distress while simultaneously enhancing their sense of hope and self-efficacy,” Thompson explained. “The successful management of uncertainty hinges on two key communication processes: informational and socioemotional, both of which carry significant clinical relevance.”
Informational competence refers to how well patients can articulate their symptoms and verify their understanding of medical explanations and guidance. This also involves doctors asking relevant questions, providing clear information, and confirming that patients comprehend what has been communicated. Moreover, the socioemotional aspect is about establishing a trusting relationship through open and honest dialogues and ensuring that patients feel emotionally supported by their healthcare providers.
Thompson collaborated with co-authors Manuel D. Pulido from California State University, Long Beach, and Dr. Paul M. Arnold along with medical student Suma Ganjidi from Carle Illinois College of Medicine to publish their insights in the Journal of Health Communication.
In 2021, over 51 million adults—roughly 21% of the U.S. population—suffered from chronic pain, leading to significant healthcare expenditures and productivity declines, as reported by the U.S. Centers for Disease Control and Prevention.
This study was grounded in uncertainty management theory, which suggests that when people face uncertainty about their health, they evaluate whether gaining information could be beneficial or threatening. For instance, patients may seek information about new symptoms to reduce anxiety or might avoid seeking information to preserve a hopeful outlook about their prognosis.
The research took place at a Midwest institution featuring several clinics dedicated to treating brain, spinal cord, and nervous system ailments. Participants ranged in age from 18 to 75, experiencing pain in various areas, including the neck, back, buttocks, and legs, with females comprising about 59% of the sample.
Before their consultations, patients completed surveys that assessed how they felt about their pain and their levels of certainty or uncertainty. They, along with their providers, filled out post-consultation surveys that evaluated their communication skills.
Patients assessed how well the healthcare provider ensured that they comprehended the provided explanations and how effectively they addressed their medical concerns.
To assess changes in patient uncertainty, pre- and post-consultation surveys asked patients to rate their levels of certainty regarding six elements of their pain, including the cause, diagnosis, prognosis, treatment options, and the associated risks and benefits. Patients also rated their tendency to catastrophize, indicating their fears of ongoing pain without relief.
The research team discovered that patients experienced reduced distress when they and their physician mutually recognized each other’s effectiveness in exchanging medical information and when patients felt emotionally supported by their doctors.
“Patients’ evaluations of their providers’ communication skills significantly predicted reductions in their pain-related uncertainties, fears, and anxiety, as well as increases in their positive outlook regarding uncertainty and confidence in managing pain,” Thompson noted. “The providers’ assessments of patients’ communication abilities were similarly linked to decreased pain-related uncertainties and modest improvements in positive views on uncertainty.”
In a related study involving a subset of spinal pain patients, the team found strong connections between patients’ satisfaction, their trust in doctors, and the degree to which doctors exceeded expectations for shared decision-making and effective history-taking and interpersonal skills. U. of I. graduate student Junhyung Han contributed as a co-author to that research, which was published in the journal Patient Education and Counseling.
The researchers emphasized the importance of mutual discussions between providers and patients regarding expectations about testing, medication, and treatments, including which options should be pursued to align with patients’ pain relief goals.
Thompson pointed out that although these studies highlight the impact of providers’ communication abilities on patients’ emotional states and perceptions about their conditions, patient communication skills are equally crucial.
“I aim to challenge the stereotype that pain patients are ‘difficult’ due to unrealistic expectations,” Thompson stated. “Regardless of how high their expectations may be, what truly influences the outcomes of conversations is whether those expectations are met or surpassed.”
“Consultations represent the beginning of what may be a lengthy and challenging journey for these patients, so it’s vital for them to learn effective therapies and strategies to manage their pain and uncertainties,” she added. “Equipping them with the tools and vocabulary to express their symptoms and concerns can enhance their interactions with providers. Understanding the complex nature of pain can validate their fears, while educating them about various treatment options like cognitive behavioral therapy may improve their coping abilities and dispel feelings of helplessness and fear.”
This research was made possible through a Campus Research Board award from the University of Illinois.
