Reassurance during low back pain consultations with GPs: a qualitative study

Background:
Reassurance is commonly recommended in guidelines for the management of low back pain in primary care, although it is poorly defined, and what it means to patients remains unknown.
Aim:
To explore low back pain patients’ perceptions of practitioners’ reassuring behaviours during consultations.
Design and Setting:
Twenty-three Patients who had recently consulted for non-specific low back pain were recruited from General Practice (GP).
Method:
Semi-structured interviews explored what patients had found reassuring during their consultations and the effect of such reassurance since their consultations. Transcripts were analysed using the Framework Method. The thematic framework was developed between two researchers, with consensus achieved through discussion.
Results:
Patients each brought experiences, beliefs, expectations and concerns to their consultations, which they wanted the doctor to hear and understand. Patients were reassured implicitly when it seemed that the doctor was taking them seriously and wanted to help, as well as through relationship-building and feeling that the doctor was readily available to them. However it was only explicit, informational reassurance which directly addressed patients’ concerns by providing explanations which ruled out serious disease, and helped them to understand and cope with their pain.
Conclusion:
The themes of implicit and explicit reassurance uncovered here correspond with ideas of affective and cognitive reassurance, respectively. While the findings support the use of information and education to alleviate concerns, the role of implicit reassurance through relationship building and empathy remains less clear. The impact of these behaviours on outcomes should form a priority for future research.