Table 2 Summary of papers identified exploring consultation experiences in OA

Alami (2011),France [24]

81 patients, 11 GPs, 6 Rheum, 4 Orth, 4 Alt Med

Interviews

To explore views on management and barriers to improvement

Patients report importance of doctor patient relationship and various barriers to treatment including side effects, fear of addiction, fear of masking pain, and a wish to focus on preventative options. GP’s report range of attitudes including the belief that OA is not a disease. Some patients and GPs identified OA as an area of uncertainty for GPs.

Not always clear which results (health care practitioners) pertained to GPs. No findings in results to support author claims in abstract and conclusion that patients feel they are not taken seriously and that GPs act as ‘technicians’; findings do not entirely match authors’ conclusions.

Busby (1997), UK [18]

80 patients, 3 GPs, 1 Rheum

Interviews fieldwork

To understand perceptions and experiences of OA

Patients describe multiple attempts at seeking healthcare, explanations couched in terms of ageing meant OA was inevitable and that nothing could be done. GPs report lack of therapeutic options threatening doctor-patient relationship.

Results in book chapter. Authors’ report findings from GPs don’t constitute ‘a systematic study’. 80 patients but only 7 cited in findings. No reported analysis methods.

Coar (2004), UK [23]

9 GPs, 3 Physio, 3 Rheum

Interviews

To explore GP’s beliefs and attitudes regarding OA

Diagnosis and use of ‘wear and tear’ emergent themes. Use of ‘wear and tear’ perceived as acceptable and useful given lack of alternative terms. Evidence of practitioners playing down severity.

MPhil thesis. Author (GP) reports on limitations and influence of interviewing their peers.

Davis (2004), USA [34]

57 Patients

Focus groups

To explore barriers to chronic pain management in arthritis

In the theme ‘relationship with healthcare providers’, patients describe unwelcome focus on prescriptions, and miscommunication in the consultation.

Small part of results relevant to this review; ‘Relationship with healthcare providers’ was one of nine emergent barriers to pain management

De Bock (1992), Netherlands [35]

14 GPs

Interviews [Medical record review]

To explore GP’s ‘policy’ in managing OA

Marked variance in the perceived importance and management of OA. Authors conclude consensus needed

Small part of results relevant to this review; small focus on interview findings in results. Little information on analysis of qualitative data.

Gignac (2006), Canada [17]

53 patients

Focus groups

To compare health experiences of middle aged and older adults with OA

Patients reported being told OA was normal for age, going to get worse, and were encouraged to accept their symptoms. Conversely, patients felt they had more control over the trajectory of OA. Delays in diagnosis reported and insufficient communication around prescriptions

Study design included ‘control’ focus groups which did not appear to add to conclusions or findings.

Glauser (2011), USA [33]

152 GPs, 99 NP & PAs

[Vignettes] survey

To examine the knowledge, attitudes and beliefs and practice of GPs regarding management of OA

Most common educational need identified in free text part of survey was around treatment

Small part of results relevant to this review; methods state researchers elicited barriers to care and confidence in managing OA, but only vignette results and educational needs reported in results. As a result, results mainly address ‘practice’ aspect of study aim.

Grime (2010), UK [22]

27 patients

Interviews

To explore perceptions of wellness in elderly people with OA

Reports both discordance and acceptance of ‘wear and tear’ used in diagnosis

Small part of results relevant to this review; most of the results relate to everyday activities and not consulting with a doctor.

Hill (2010), UK [29]

29 patients

Focus groups

To explore perceptions and experience of treatment and management of hand OA

Patients described dissatisfaction with amount of information, feeling that ‘nothing can be done’, and held perceptions that GPs lacked understanding of the impact of hand OA. Authors conclude some of the findings imply lack of knowledge of treatment options.

Sample included 14 patients from secondary care, and not always clear which setting consultation experiences related to.

Jinks (2007), UK [20]

22 patients

Survey interviews

To investigate population and individual needs assessment

Patients report being told their pain is ‘wear and tear’, related to age, to ‘live with it’ and that nothing can be done. Patients also held the view nothing could be done.

Small part of results relevant to this review; most of the results relate to living with knee pain. Patients were > 50 years and had self-reported knee pain, and may not all have had OA.

Kee (1998), USA [37]

20 patients

Interviews

To gain an ‘insider view’ of living with OA

The theme ‘staying in charge’ describes patients’ lack of adherence with GP recommended interventions, with examples of miscommunication.

Small part of results relevant to this review; most of the results relate to living with OA.

Kingsbury (2012), UK [31]

232 GPs

Survey

To identify GP reported management of OA

GPs described barriers to effective OA management including inability to manage pain adequately, time in the consultation and enabling patients to make lifestyle changes.

Small part of results relevant to this review; most of the findings relate to self-reported GP behaviours. Low response rate

Lambert (2000), USA [28]

12 patients, 14 Doctors (including GPs, rheum and others)

Focus groups

To understand views and experience of OA care and expressed needs

Patients value ‘low-tech’ treatments with doctors tending to value medicines and surgery. Doctors report OA as being related to ageing, which patients report as difficult to accept. Doctors reported lack of musculoskeletal training as an issue, and specific educational needs were identified.

Authors do not specify number of GPs, and sample includes other secondary care doctors; not clear which findings relate to GPs.

Mann (2011), UK [16]

16 patients, 2 GPs, 1 Rheum, 1 OT, 2 Physio, 4 NPs

Focus groups and interviews

To explore views on provision of care and possible improvements

Patients reported delays in diagnosis, a feeling that ‘nothing was done’, and difficulty knowing when to return to the doctor. Patients reported OA was not a priority and health professionals reported lack of time as an issue. A GP participant reported not perceiving a need for patient information, although the HP as a whole identified a need for more information

Only 2 GP participants.

McHugh (2007), UK [27]

21 Patients

Semi-structured interviews

To investigate the experiences of patients on the waiting list for joint replacement

Patients reported hiding their symptoms from their GP after previous negative experiences.

Small part of results relevant to this review; much of the results about living with OA and self-management etc.

Pitt (2008), Australia [36]

13 GPs

Focus groups semi-structured interviews

To explore enablers and barriers to referring patients with OA to self-management programmes

A range of referral patterns and attitudes to self-management in OA were uncovered. Barriers to referral included GPs holding the belief that OA was different to other chronic diseases and time in the consultation

Small part of results relevant to this review; attitudes to OA not primary objective of researchers, and so attitudes elicited were only those of relevance to self-management programme referral. Small sample.

Rosemann (2006), Germany [32]

20 patients 20 GPs, 20 NPs

Interviews

To identify health care needs and obstacles for improvements

Patients reported pain and fear of disability as their most important concerns that were inadequately addressed in the consultation, with insufficient information about prognosis. Doctors reported resource issues as barrier to effective treatment, while patients reported communication deficits.

Issues of transferability due to healthcare funding in Germany which reportedly does not ‘value’ conservative treatments equally with non-conservative, and due to large number of non-surgical orthopaedic specialists working in primary care. More findings reported from GPs than patients.

Sanders (2002), UK [19]

27 patients

Interviews

To examine the meanings of symptoms of OA

Delays in diagnosis reported. Older participants reported down-playing symptoms.

Small part of results relevant to this review; paper concerns general experience of living with OA.

Sanders (2004), UK [25]

27 patients

Interviews

To explore barriers to joint replacement

Participants describe being told nothing can be done; often those who asked about surgery reported being told they were unsuitable for various reasons, including age, by their GP

Small part of results relevant to this review; data extracted from one of 3 themes relating to experiences of primary care.

Thomas (2013), UK [30]

11 patients

Semi structured interviews

To describe patient experience of seeing their GP with foot OA

Patients described being given little information, felt foot OA was low priority, and felt there was an ‘unwelcome focus on drugs’.

Conference Proceeding, and therefore limited information on findings

Turner (2007), UK [26]

31 patients

Interviews

To investigate beliefs about causes of OA

‘Overwhelming majority’ reported no negative psychological reaction to diagnosis. Some patients reported that GPs had reinforced the belief that OA would deteriorate over time.

Small part of results relevant to this review, around the theme of diagnosis.

Victor (2004), UK [21]

170 patients

Interviews [Patient diaries, Group sessions]

To explore patients’ perspective on meaning and significance of OA

Participants reported a lack of information that had been given by GPs previously and uncertainty about the nature, self-management and outcomes of OA.

Small part of results relevant to this review; research conducted in the context of a randomised controlled trial therefore only data relating to participants' previous interaction with healthcare was extracted.