Radiographic imaging for non-specific low back pain: the communication of radiology report findings.

Abstract

Non-specific low back pain is a major health and economic problem and cited as one of the most common reasons for consulting a primary care physician. The aim of this research was to understand the relationship between actions, situations and consequences; firstly by establishing how radiology reports are communicated to patients following a referral for lumbar spine radiographic imaging for non-specific low back pain and secondly, how this may influence the outcome (symptoms and behaviour) for an individual from their perspective. A qualitative approach focused the attention on the research problem. Semi- structured telephone interviews were used to establish how radiology report findings were communicated to the participants. These interviews were then transcribed, analysed and interpreted. To ensure quality, minimise investigator bias and unwarranted selectivity, the radiology report for each of the participants was also analysed. By focussing on the implied meaning of the text of the report, this second data source was used to determine whether the communication of the radiology report findings had been effective. Twenty-three patients were interviewed, sixteen women and seven men, with a mean age 57 years (range 47 to 65 years). All participants said they felt reassured by the referral for radiographic imaging and the majority returned to their GPs for the results of the investigation. After receiving the results however, only around half of the participants in this research seemed to understand the report and felt reassured by its findings. They were glad to have a diagnosis and they had a positive attitude towards the outcome. While generally they were pleased that there was nothing significant or dangerous and they could be treated, not all were happy to be told that they had age related wear and tear or degeneration. Those who were not reassured by the report findings seemed to either not really understand the results or had misinterpreted the results. They reported being despondent and unsurprised and that it (their low back pain) was something that they would have to live with. This research has shown that despite guidelines which state that radiographic imaging of the lumbar spine should not be offered to those with non-specific LBP (NICE 2009), GPs are continuing to request lumbar spine imaging for their patients with non-specific low back pain. The research found that patients, who were reassured by the findings described in the radiology report, were glad to have a diagnosis and it gave them the confidence to pick up their lives, and most continued to work. However, this research also identified that when there is misinterpretation or a misunderstanding of the intended meaning of the radiology report, the outcome for patients was dissatisfaction and despondence, with some unable to work. The findings of this research suggest that improving communication between the Radiologist and the GP and between the GP and the patient may reduce the burden of chronic low back pain.