“My gut feeling is…”: An ethnographic study exploring interprofessional communication about children and adolescents with chronic musculoskeletal pain in paediatric rheumatology.

Jul 17, 2023

Contributors: Rebecca Rachael Lee,Janet E McDonagh,Tim Rapley,Albert Farre,Mark Connelly,Tonya M Palermo,Karine Toupin-April,Emily Wakefield,Sarah Peters,Lis Cordingley

Interprofessional communication about inflammatory and non-inflammatory musculoskeletal conditions is an important component of assessment and management in paediatric rheumatology. Chronic pain is a feature of some of these conditions which likely influences the extent and type of communication about pain. Research investigating interprofessional communication about paediatric pain is limited but has found that communication is inclusive of the biopsychosocial context of children/adolescents as well as their families. The aim of this ethnographic study was to explore interprofessional communication about children and adolescents with chronic musculoskeletal pain in paediatric rheumatology. We observed forty-five healthcare professionals recruited from three UK paediatric rheumatology teams during thirty multi-disciplinary team meetings. Contemporaneous field notes created during observations were analysed using grounded theory procedures. Core processes identified in interprofessional communication involved describing, making sense of, and managing children/adolescents with pain and their families. Topic areas discussed within these core processes included healthcare professional perceptions about children’s and parents’ personality characteristics, as well as healthcare professionals’ familiarity with families. Underlying diagnoses and possible attributions of pain aetiology were also discussed. Interprofessional narratives included consideration of the potential anxieties and uncertainties about pain within families. Healthcare professionals communicated about strategies for managing expectations about pain. These findings characterise the nuances in interprofessional communication about pain and can be used to inform future work aimed at understanding and optimising the impact of interprofessional communication on clinical decisions and pain outcomes. PERSPECTIVE: This study characterises the processes [series of actions], the function [purpose] and the content [topic areas] of interprofessional communication about paediatric pain in rheumatology settings. These findings should be used to inform interventions targeting both the appropriateness and effectiveness of this communication.
Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE CONTRIBUTORS

Rebecca Rachael Lee,Janet E McDonagh,Tim Rapley,Albert Farre,Mark Connelly,Tonya M Palermo,Karine Toupin-April,Emily Wakefield,Sarah Peters,Lis Cordingley
Rebecca Rachael Lee

Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK. Electronic address: rebecca.lee-4@manchester.ac.uk.

Janet E McDonagh

Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK.

Tim Rapley

Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria, UK.

Albert Farre

School of Health Sciences, University of Dundee, Dundee, UK.

Mark Connelly

Division of Developmental and Behavioral Health, Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, USA.

Tonya M Palermo

Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA.

Karine Toupin-April

School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Institut du savoir Montfort, Ottawa, ON, Canada.

Emily Wakefield

Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut, USA.

Sarah Peters

Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.

Lis Cordingley

Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK.