This is a plain English summary of an original research article
Some people with osteoarthritis feel healthcare professionals don’t listen to their concerns, and don't fully recognise the impact of their pain. At the same time, some healthcare professionals feel that people have unrealistic expectations of treatment. Research found that the two groups have different concerns and treatment priorities, and neither spends enough time talking about osteoarthritis in consultations.
People with osteoarthritis can have painful and stiff joints. They may see GPs, nurses or physiotherapists to help them manage their condition. Previous research has shown that positive interactions with professionals help people manage their own health.
This study was a review of previous research on priorities and concerns about osteoarthritis. It explored the attitudes of people with the condition, and of professionals in primary care. It explored issues in the management of osteoarthritis and identified areas for improvement.
The authors concluded that consultations could be improved if professionals actively listened to people more, and validated their concerns. Using clear, non-technical language and sharing tailored information could promote mutual trust and respect. This would help create a positive relationship, encourage people to engage with treatment decisions and to manage their own condition.
What’s the issue?
Osteoarthritis causes joints to become painful and stiff. It is the most common type of arthritis in the UK, and most often occurs in people over 45 years. It can be difficult for people with osteoarthritis to move the affected joints (often knees, hips or hands). There is no cure for the condition, but it does not necessarily get worse over time.
Management of osteoarthritis can involve lifestyle changes (maintaining a healthy weight and exercising regularly), and medicines to relieve pain. Supportive treatments can include hot or cold packs, or assistive devices to help people carry out everyday tasks.
People who have positive interactions with healthcare professionals are more likely to actively manage their own condition. For those with osteoarthritis, this can mean they experience less pain and have an improved quality of life.
However, studies have shown that many people with osteoarthritis report negative interactions with healthcare professionals. Some delay seeking help because they are concerned that their pain will not be taken seriously, and their condition will be poorly managed.
This study examined priorities and concerns in the management of osteoarthritis. It focused on areas in which people with the condition held different views from healthcare professionals. This allowed the authors to make recommendations to improve interactions.
The review was based on 26 articles about attitudes towards managing osteoarthritis. The studies were carried out in primary care and community settings in high-income countries around the world. In all, they included 557 people with osteoarthritis and 199 professionals (mostly GPs, nurses and physiotherapists but some studies included mixed professional groups such as rheumatologists, surgeons, alternative medicine practitioners and occupational therapists).
The review found that people with osteoarthritis:
- felt their condition and its impact on their life was not taken seriously; some thought doctors dismissed the symptoms of osteoarthritis as an inevitable part of ageing, which made them feel helpless
- thought doctors seemed distant and hurried; they wanted time to express their concerns, to feel trusted and listened to
- wanted clear and consistent information that did not include medical jargon
- wanted care to be tailored to them as individual people, which could mean professionals taking an holistic approach to osteoarthritis, and considering physical, social and psychological aspects of pain and disability.
The review found that professionals:
- were concerned that people with osteoarthritis had unrealistic expectations of treatment and did not always follow their advice to lose weight or exercise
- saw self-management as a key goal, though many GPs felt unqualified to advise on exercises
- thought that education on osteoarthritis was important but they did not always prioritise it
- were frustrated that people sometimes mentioned relevant problems related to osteoarthritis too late in a time-limited consultation for them to take meaningful action.
As a result of these findings, the authors recommend that professionals:
- listen to and validate people’s concerns; people may need support to elaborate on their priorities
- avoid negative terms such as ‘wear and tear’, and use positive language to help people feel more optimistic about managing their condition
- consider all the ways osteoarthritis is having an impact (including pain, reduced mobility, socially and emotionally)
- treat people as individuals and personalise treatment to address their specific needs.
The authors recognise that GPs have limited time. But they say the impact of osteoarthritis on everyday life means it may need to be prioritised in consultations.
Why is this important?
This research highlights areas in which people with osteoarthritis have different priorities and concerns to the professionals providing their care. The authors’ recommendations could promote trust and empathy in interactions and lead to more shared understanding.
Shared understanding can improve the quality of people’s care, and their quality of life. GPs may be concerned that this will add to the length of consultations. However, previous research has found that helping people to express their concerns need not take extra time. In addition, clinicians who treat patients with empathy can experience less burnout and greater job satisfaction.
Shared understanding can therefore improve interactions for both professionals and people with osteoarthritis. This could help them work together to agree realistic and shared goals for management.
Guidance from the National Institute for Health and Care Excellence (NICE) recommends that professionals take a holistic approach to osteoarthritis, increase people’s understanding and encourage self-management. A consultation is underway to update the guidelines.
However, the researchers say this may be difficult to achieve when professionals and people with osteoarthritis have different concerns and priorities. They stress the importance of eliciting people’s concerns and working towards shared understanding and decision-making. Good communication can lead to reduced pain, and improved quality of life and satisfaction with care.
Professionals' communication skills are essential to good healthcare interactions. Enhancing these skills is particularly relevant following the recent 2020 pandemic when remote consultations brought additional challenges to primary care.
The researchers have developed a brief intervention for practitioners to enhance empathic and optimistic communication. It focuses on verbal and non-verbal communication within primary care. They are evaluating this training. Enhancing practitioners' communication skills through brief training could improve outcomes for people living with osteoarthritis and other conditions, the researchers say.
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This NIHR Alert is based on: Vennik J, and others. Patient and practitioner priorities and concerns about primary healthcare interactions for osteoarthritis: A meta-ethnography. Patient Education and Counselling 2022;105:1865–1877
Research from the same team on the views of people with osteoathritis: Lyness E, and others. Exploring patient views of empathic optimistic communication for osteoarthritis in primary care: a qualitative interview study using vignettes. BJGP Open. 2021;30:5
Evidence-based information for clinicians and people with osteoarthritis: Joint Implementation of Osteoarthritis Guidelines Across Western-Europe (JIGSAW-E).
Funding: This study was funded by the NIHR School for Primary Care Research.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.