Self-Management Support and Communication from Nurse Care Manager Compared to Primary Care Physicians: A Focus Group Study of Patients With Chronic Musculoskeletal Pain

Matthias M, Bair MJ, Damush TM. Self-Management Support and Communication from Nurse Care Manager Compared to Primary Care Physicians: A Focus Group Study of Patients With Chronic Musculoskeletal Pain. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2008 Apr 11; Pittsburgh, PA.

BACKGROUND: While it is well established that physician-patient communication directly impacts health outcomes, little attention has been devoted to studying communication with other care providers such as nurse care managers (NCMs). A better understanding of the communication between patients and NCMs is particularly important given the increasing role NCMs are playing in chronic disease management, especially in the primary care setting. Our objective was to identify how patients perceived their communication with NCMs and primary care physicians in the management of chronic musculoskeletal pain. METHODS: We conducted four focus groups. Patients were recruited from VA and university primary care clinics after completion of a randomized clinical trial. The trial tested a 6-session pain self-management program combined with antidepressant therapy for patients with comorbid depression and chronic pain. Nurse care managers delivered the intervention. Groups consisted of three to six patients and were stratified by gender. An experienced moderator facilitated the sessions, guided by semi-structured questions addressing care received from providers and self-management strategies delivered during the trial. Groups were audio-taped and transcribed. Analysis of transcripts identified emergent themes from patient narratives of their experiences with their physicians and NCMs. Three researchers independently coded transcripts using constant comparison methodology. Discrepancies were resolved by consensus. RESULTS: Patients (N = 18) were 27 to 84 years old (M = 54.8), 61% women, 72% White, and 22% Black. One-third of the sample was veterans. Regarding the roles their physicians and NCMs played in the management of their pain, participants described the NCMs as “helpful” and “understanding.” Patients felt that the NCM took the time to listen to them (“It was good to talk to somebody.”) and genuinely cared about their well-being (“She really took a lot of interest in me.”), while at the same time encouraging them to continue their self-management strategies (“You need that backbone to remind you to keep going and say, hey, you're doing good, let's keep going.”). In contrast, patients felt that their physicians did not spend enough time with them, did not understand what it was like to be in constant pain (“They don't know what the pain feels like.”), and did not listen to them (“They need to sit down and listen to their patients and find out what is going on.”). Similarly, many patients also commented that their doctors wanted to “push” medications rather than identifying the cause of the pain (“My doctor just wants to push prescription after prescription, and I didn't want to hide the pain, I wanted to fix it.”). CONCLUSIONS: Our study demonstrates that the NCMs provided valuable encouragement and emotional support—two critical aspects of patient-centered, chronic pain care that physicians may be challenged to provide because of time constraints. These results carry two major implications: 1) suggestions for how primary care physicians can improve care to patients suffering from chronic pain (e.g., active listening to patients); 2) advantages of a pain self-management program delivered by nurse care managers, who provide patients with support and non-pharmaceutical strategies to relieve pain.