"Doctor-Led, Patient-Centered": A Mixed-Method Research Comparing Patients' and Doctors' Treatment Outcome Choices for Chronic Low Back Pain.

Abstract

Background: Chronic low back pain (CLBP) significantly impacts quality of life. Treatment outcomes are influenced by the perspectives and expectations of both patients and doctors, making it crucial to understand these views to optimize care and satisfaction.

Purpose: This study aims to analyze the alignment and differences in doctors' and patients' perceptions of treatment outcomes and explore the implications of these differences.

Methods: An explanatory sequential mixed-methods design was used, involving a questionnaire survey and two focus groups. The study was conducted at Dongzhimen Hospital from August 2020 to January 2021. Participants, including patients with any type of CLBP (age≥18) and doctors with at least one year of experience, were selected via purposive sampling. Quantitative data, analyzed with SPSS, were summarized as percentages for categorical variables and as means with standard deviations or medians for continuous variables. Differences between variables were assessed using the Chi-square and nonparametric rank sum tests. Focus group discussions were analyzed thematically to explore differing perspectives on treatment outcomes.

Results: A questionnaire gathered perspectives from 30 patients (mean age 45±11.74 years) and 26 doctors (mean age 41.7±6.7 years). The results informed the development of specific questions for focus group interviews with 8 patients and 8 doctors. Quantitative results revealed that pain/discomfort and activities of daily living were equally important to both groups. However, many outcomes were valued differently. Five themes emerged: 1) Doctors' focus on treating the whole person; 2) Patients' emphasis on cost-effectiveness/satisfaction; 3) Patients' prioritization of body image and physical function; 4) Shared priority beyond pain; 5) Shared concerns on adverse events.

Conclusion: This study highlights the importance of aligning treatment expectations between patients and doctors to improve satisfaction and outcomes in CLBP management. Enhanced communication strategies and shared decision-making are recommended to bridge these gaps.