Did older patients with musculoskeletal pain discuss their prognosis as often as they valued it?

Details

Prognosis has been described as an important but neglected branch of clinical science. Although patients’ views have been sought in life-threatening illness, similar research has been lacking for people presenting with common, non-life-threatening musculoskeletal complaints. This study asked whether and why older patients with musculoskeletal pain considered prognostic information important, and how often they felt it was discussed in a general practice consultation.

Researchers conducted a cross-sectional survey of consecutive patients aged 50 and over presenting with non-inflammatory musculoskeletal pain at five Central Cheshire general practices. They described the frequency of responses to prognostic questions and used logistic regression to explore associations with sociodemographic, presenting pain complaint and psychosocial variables.

A total of 502 participants (77%) responded to the postal questionnaire, and 165 (33%) reported discussing prognosis in their GP consultation. Such discussions were more often reported by male patients (OR 1.72, 95% CI 1.09–2.71) and those attending their first consultation (OR 1.81, 95% CI 1.16–2.80); 402 participants (82%) thought prognostic information was important. This view was most common among those currently in paid employment (OR 2.95, 95% CI 1.33–6.57).

Reasons for valuing prognostic information included knowing for the sake of knowing and planning future activity. Reasons for not considering it important included beliefs that pain progression was inevitable and that nothing could be done to help.

The researchers concluded that older people with musculoskeletal pain considered prognostic information important, yet such discussions occurred infrequently in primary care. The barriers to effective prognostic communication and patients’ exact information needs remain unknown and warrant further research.