The Executive Suite: Physician-patient communication during initial consultation affects outcomes for chronic pain patients

A study from the University of Illinois Urbana-Champaign, published in the Journal of Health Communication, looked at 200 adults with chronic neck or back pain, and reported that effective physician-patient communication during the initial consultation can have significant implications toward patients’ overall outcomes. According to Charee Thompson, the communications professor behind the study, patients were better equipped to manage their uncertainties, including fears, anxiety and confidence in their own ability to cope with their condition, as a result of effective communication during their first consultation.

“We found that providers and patients who perceive themselves and each other as competent medical communicators during consultations can alleviate patients’ negative feelings of uncertainty, such as distress, and increase their positive feelings about uncertainties, such as their sense of hope and beliefs in their pain-management self-efficacy,” Thompson said in a university release. “Providers and patients successfully manage patients’ uncertainty through two fundamental medical communication processes—informational and socioemotional, each of which can have important clinical implications.”

Patients’ ability to both accurately describe their symptoms to physicians, and verify their understanding of physicians’ explanations and instructions, were determined to be important parts of the process. In addition, clinicians asking appropriate questions, providing clear explanations and confirming that patients understand their explanations and instructions, are crucial for the significant portion of the population currently suffering from chronic pain. According to a CDC report, 20.9% of U.S. adults—roughly 51.6 million individuals—experience chronic pain, as of 2021.

The study considered the theory of uncertainty management, which hypothesizes that people, when faced with uncertainty about a health condition, will appraise it and make a decision about whether it would be beneficial, or a threat, to obtain more information. Patients may look for new information about a new symptom they’re experiencing in order to mitigate their anxiety, or they may choose to avoid any information, so they can maintain hopeful uncertainty, which could also be considered blissful ignorance.

The study looked at several clinics and programs that treat diseases and injuries of the brain, spinal cord and nervous system. The sample population ranged in age from 18-75, and about 59% were female. Prior to the consultation, patients filled out surveys rating their experience, management, and level of uncertainty regarding their own pain. Then, patients and physicians completed post-consultation surveys rating themselves, and each other, on communication skills.

On both the pre- and post-consultation surveys, patients were asked to rate their level of uncertainty regarding several specific aspects of their pain, and they were asked to rate whether they were catastrophizing. Feelings of hopelessness and distress in patients were reduced when they agreed with their physicians that the other person was an effective communicator.

“Patients’ ratings of their providers’ communication competency significantly predicted reductions in their pain-related uncertainty and in their appraisals of fear and anxiety, as well as increases in their positive uncertainty and pain self-efficacy,” Thompson said. “Providers’ reports of patients’ communication competency were likewise associated with decreases in patients’ pain-related uncertainty and marginally significant improvements in their positive appraisals of uncertainty.”

Thompson clarified that, although the study emphasized the importance of the providers’ communication skills, and the effect they have on patient outcomes and emotions, communication is a two-way street, and patients’ communication skills are similarly important.

“Consultations mark what may be a long, challenging diagnostic and treatment journey for these patients, and they could benefit from learning about therapies and strategies to help them manage their pain and uncertainties,” Thompson explained. “Giving them the tools and language to communicate their symptoms and concerns to providers could make their interactions more productive. Learning about the uncertain nature of pain may validate their fears and anxieties, while awareness and education about the various treatment options and therapies such as cognitive behavioral therapy could enhance their coping and dispel feelings of helplessness and fear.”