How can primary care clinician’s optimise patient expectations about OA management? An exploratory study investigating patient perspectives about positive framing in the OA consultation.

Talk Code: 
Emily Lyness
Felicity L Bishop, Jane Vennik, Jeremy Howick, Stephanie Hughes, Kirsten Smith, Mohana Ratnapalan, Christian Mallen, Leanne Morrison, Lucy Yardley, Hajira Dambha-Miller, Geraldine Leydon, Paul Little, Hazel Everitt.
Author institutions: 
University of Southampton, Unversity of Oxford, Keele University.


Osteoarthritis (OA) is a common condition causing pain and reduced mobility that can have a significant impact on people’s lives. It has a growing prevalence in the UK due to rising risk factors and patients frequently present to primary care practitioners. Experimental studies suggest that enhancing clinicians’ communication of positive expectations regarding the management of OA may reduce patient experience of OA pain and encourage positive outcome expectations. It is unclear, however, how this fits into real world practice and there is limited insight into patient’s views about the role of expectation management. This qualitative study explores the views of patients with OA on the use of positive messages in the primary care consultation to shape outcome expectations.


This study was embedded within Empathica; a SPCR funded project developing a digital intervention to enhance practitioner skills in empathic communication and expectation management. Participants were recruited from primary care practices with the assistance of the Clinical Research Network (CRN) to include patients over 45 who had consulted for hip/knee OA in the last 12 months. 18 participants were purposefully sampled to include a range of age, gender, severity of OA and deprivation index.

Semi-structured interviews were conducted using a combination of vignettes and open-ended questions to elicit participants’ views. Two case vignettes were developed with input from a PPI representative to illustrate different clinician approaches to expectation management in a primary care OA consultation. One vignette depicted a neutral factual approach, the other included clear positive messages and phrases informed by the literature and expert opinion. The topic guide was developed inductively with open-ended questions to allow flexible responses and explore developing themes. Both vignettes were presented to each participant in a random order to avoid bias. Interviews were audio-recorded, transcribed and anonymised. Thematic data analysis was conducted using an inductive approach with techniques from grounded theory using NVIVO software.


Emerging themes appear to suggest that positive messages need to be combined with an empathic clinical approach to be effectively delivered. If this balanced approach could be achieved patients felt it may enhance patient optimism about management and their ability to control health behaviours, and therefore symptoms. There was however some scepticism whether this was achievable in the time and resource constrained environment of NHS primary care.


We hypothesise that applying experimental theory of delivering positive messages is likely to be challenging within the real world context due to the complex interplay between chronic disease management and the current pressures on primary care service delivery. However, in the correct setting may enhance the patient engagement with self-management of their disease.

Analysis will be complete and full results and conclusions will be available at the conference.

Submitted by: 
Emily Lyness
Funding acknowledgement: 
The EMPATHICA trial is supported by a National Institute for Health Research (NIHR) School for Primary Care Research grant (project number 389). The Primary Care Department is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. HDM is funded through an NIHR Clinical Lectureship. MR is a GP ACF who is partly funded by the National Institute for Health Research (NIHR) School for Primary Care Research. CDM is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and social care.