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

Nicola Holt, Tamar Pincus, Steven Vogel

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. To explore how patients with low back pain perceive practitioners' reassuring behaviours during consultations. Qualitative study undertaken with patients from nine GP surgeries in Northamptonshire, England. Twenty-three patients who had recently consulted for non-specific low back pain were recruited from general practice. Semi-structured interviews explored what they had found reassuring during their consultations and the effect of such reassurance since their consultations. Interview transcripts were analysed using the thematic framework method. Patients each brought to their consultations experiences, beliefs, expectations, and concerns that they wanted the doctor to hear and understand. They were reassured implicitly when it seemed the doctor was taking them seriously and wanted to help; this was also achieved through relationship building and feeling that the GP was readily available to them. However, it was only explicit, informational reassurance that directly addressed patients' concerns by providing them with explanations ruling out serious disease, and helped them to understand and cope with their pain. The themes of implicit and explicit reassurance uncovered here correspond with ideas of affective and cognitive reassurance, respectively. Although 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.