A qualitative exploration of emergency clinicians’ experiences of caring for patients presenting with back pain

Capsey, Matt ORCID: https://orcid.org/0000-0003-3659-5344 , Ryan, Cormac, Mankelow, Jagjit and Martin, Denis (2024) A qualitative exploration of emergency clinicians’ experiences of caring for patients presenting with back pain. British Journal of Pain, 18 (1_supp). p. 3.

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Abstract

Background: Back pain guidelines are predominantly based on data from primary care. The back pain population presenting to emergency medical services (EMS), including hospital emergency departments and emergency ambulance services, appears to be different to primary care with greater numbers of individuals with serious pathology. Little is known about emergency clinicians experience of delivering care to this patient group.

Aims: The primary aim of this study was to explore the experiences of emergency clinicians in caring for patients experiencing back pain. The research aim was informed through engagement with emergency clinicians and patient representatives. The objectives of the study were:
-To explore understanding of the term “back pain”.
-To explore perceptions of whether these patients make up a significant proportion of the EMS case load.
-To explore the care that clinicians provide and their confidence in offering that care.
-To explore opinions of what, if anything, would improve care for this patient group.

Methods: This was a qualitative exploration using reflexive thematic analysis to construct themes from a series of semi-structured interviews. The interviewer and primary coder (MC) was an experienced academic paramedic who had an insider position in relation to emergency care. Other members of the research team (CR, JM, DM) provided oversight and reviewed work as it progressed.

Results: Thirteen interviews were conducted with a range of emergency clinicians (doctors, paramedics, nurses and physiotherapists) four themes and ten sub-themes were constructed.
-Understanding Back Pain Participants viewed back pain as a symptom with many causes and they consider it their role to identify those with serious pathology. Gaps in training were filled through peer knowledge exchange.
-EMS can be a legitimate choice for patients. Participants recognised that patients may be worried or in pain. Patients appreciate that EMS takes it time to listen to them. EMS can provide the back stop when patients cannot access other services.
-Benign or Sinister? Participants recognised that back pain was a common presentation, however non-specific aetiology was less common than expected. The role of emergency care is to identify serious pathology using red flags and refer cases to the appropriate care.
-Treatment Options Many of the treatments provided by EMS are not advocated in current guidelines. Entonox is used by ambulance clinicians to help patients mobilise but is of limited used in the emergency department. Despite a lack of specific guidelines participants felt supported.

Conclusions: Across the range of emergency settings, clinicians have a nuanced understanding of back pain and its presentations. Clinicians were generally sympathetic to patients experiencing back pain recognising how distressing it could be. They were confident in their management of these patients but felt that national guidelines were less relevant to the emergency setting. Due to limited formal education or emergency care specific guidelines on back pain, clinicians shared their experiences through stories, frequently of patients who had serious pathology despite a benign appearance. The understanding of participants, expressed during the study, fits with the emergency medicine paradigm which starts with sinister diagnoses and works its way towards the more benign. Participants suggested that lack of availability of primary care was a driver of demand of EMS by patients with primary care appropriate back pain. Clinicians offered little criticism of patients’ decision making, recognising that patients were often distressed, and the system can be difficult to navigate. Emergency care focused guidelines, which include the management of acute exacerbations that impact on mobility, could contribute to managing EMS demand and provide better care for patients experiencing back pain.

Item Type:	Article
Journal / Publication Title:	British Journal of Pain
Publisher:	SAGE Publications
ISSN:	2049-4645
Departments:	Institute of Health > Centre for Excellence in Paramedic Practice
Additional Information:	Published abstract of poster P-06 presented at British Pain Society 57th Annual Scientific Meeting, 4-6 June 2024, Nottingham, UK.
Depositing User:	Anna Lupton
Date Deposited:	04 Oct 2024 09:35
Last Modified:	07 Nov 2024 10:20
URI:	https://insight.cumbria.ac.uk/id/eprint/8432

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