The advanced practitioners' perspective. Exploring the decision-making process between musculoskeletal advanced practitioners and their patients: An interpretive phenomenological study.

Jonathan Thompson,Lynne Gabriel,Pamela Dawson,Samantha Yoward

doi:10.1002/msc.1562

Abstract

Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions. Despite the extensive utilisation of these roles and previously reported high patient satisfaction, little is understood about how these practitioners interact with their patients and the factors that influence decision-making conversations. A qualitative study utilised Interpretive Phenomenological Analysis (IPA) to explore the decision-making process occurring between Advanced Practitioners (APs) and their patients in a musculoskeletal service. AP data were collected through focus groups and analysed using IPA methodology. Advanced practice decision-making is a complex process and APs exhibit a range of styles, from paternalistic to shared decision-making. APs may have a personal preference, but exhibit the ability to flex between styles in consultations. Multiple themes emerged from the data that influenced the decision-making process, including AP staff understanding the importance of patient expectations and the complex factors that influence patient interactions. It is important that clinicians have an awareness of the multiple factors that contribute to the decision-making process.

Highlights

Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions
The data were collated from focus group interviews with nine Advanced Practitioners (APs) working in an MSK service covering both community and secondary
The remaining three themes relate to factors that emerged as influencing and underpinning AP decision‐making

Summary

Introduction

Advanced practice roles for allied health professionals continue to expand and provide key services within pathways of care for patients with musculoskeletal conditions. Study: A qualitative study utilised Interpretive Phenomenological Analysis (IPA) to explore the decision‐making process occurring between Advanced Practitioners (APs) and their patients in a musculoskeletal service. Conclusions: Advanced practice decision‐making is a complex process and APs exhibit a range of styles, from paternalistic to shared decision‐making. Multiple themes emerged from the data that influenced the decision‐ making process, including AP staff understanding the importance of patient expectations and the complex factors that influence patient interactions. In musculoskeletal (MSK) practice, the AP role is well established, as the first Extended Scope Practitioner (ESP) roles appeared in the United Kingdom over 30 years ago (Byles & Ling, 1989).

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Results

Discussion

Conclusion