Thompson J1
1York St John University, School of Health Sciences, York, United Kingdom
Background: Extended Scope Practitioner (ESP) posts are well established in musculoskeletal services across the United Kingdom and in selected international settings. However, the evidence supporting their effectiveness and details of their interventions is limited, particularly in relation to the way ESPs interact with their patients, consider management choices and arrive at these decisions.
Purpose: This research was undertaken as part of the authors doctoral programme of study with the aim of exploring the interactions and decision-making processes that take place during consultations between ESPs and their patients in a musculoskeletal setting.
Methods: A phenomenological study was undertaken using Interpretive Phenomenological Analysis (IPA) to explore experiences of decision-making within consultations . Purposive sampling targeted musculoskeletal ESPs, and patients who had recently attended ESP appointments, within a single community musculoskeletal service. Data was collected through focus groups and in-depth interviews with 9 ESPs and 9 patients.
Data analysis led to identification of emergent themes, followed by superordinate themes linking connected material. Analysis was developed beyond purely descriptive content to a deeper level of interpretation in line with IPA methodology.
ESP and patient data were analysed separately followed by a combined analysis to explore any divergent and convergent themes. Yardley's framework (Yardley 2015) of qualitative research validity was adopted throughout to ensure rigour and trustworthiness of the study.
Results: Results demonstrated the complexities of the clinical relationship and how ESPs and their patients collaborate to enable patients to make informed healthcare decisions. Clinical relationships were positive and productive, based upon a shared understanding and alignment of decision-making preferences. Decision-making is most frequently undertaken as part of a collaborative shared style, showing ESP care is aligned to contemporary patient-centred and co-produced care.
Effective communication, an awareness and understanding of patient expectations and a combination of internal and external influences, including stress and anxiety, and other clinical and family relationships play an important role in decision- making. Patients lack awareness of the ESP role, however clearly placed trust in the ESP clinicians and were very satisfied with the care provided. Details of how ESPs consider the stresses and risks of their advanced roles have emerged, alongside ways in which these stresses may be managed. There is also insight into how ESP staff develop into their roles and consider the clinical competencies required to practice safely, transitioning from a traditional allied health professional role to that of an advanced practitioner.
Conclusion(s): Musculoskeletal ESPs and patients most frequently adopt a shared style of decision- making. Effective communication, clinical relationships, patient expectations and internal and external influences are the key factors impacting upon the decision-making process.
Implications: Increased understanding of the factors affecting patient consultations and decision- making has the potential to increase the effectiveness of advanced practice roles and provide more effective patient-centred care.
Understanding the risks and stresses associated with advanced practice roles could enable staff to identify and manage these issues more effectively reducing the potential risk of professional burnout.
Keywords: Musculoskeletal, Decision-making, Advanced practice
Funding acknowledgements: This work was supported by grants from the Chartered Society of Physiotherapy and the Advanced Practice Physiotherapy Network
Purpose: This research was undertaken as part of the authors doctoral programme of study with the aim of exploring the interactions and decision-making processes that take place during consultations between ESPs and their patients in a musculoskeletal setting.
Methods: A phenomenological study was undertaken using Interpretive Phenomenological Analysis (IPA) to explore experiences of decision-making within consultations . Purposive sampling targeted musculoskeletal ESPs, and patients who had recently attended ESP appointments, within a single community musculoskeletal service. Data was collected through focus groups and in-depth interviews with 9 ESPs and 9 patients.
Data analysis led to identification of emergent themes, followed by superordinate themes linking connected material. Analysis was developed beyond purely descriptive content to a deeper level of interpretation in line with IPA methodology.
ESP and patient data were analysed separately followed by a combined analysis to explore any divergent and convergent themes. Yardley's framework (Yardley 2015) of qualitative research validity was adopted throughout to ensure rigour and trustworthiness of the study.
Results: Results demonstrated the complexities of the clinical relationship and how ESPs and their patients collaborate to enable patients to make informed healthcare decisions. Clinical relationships were positive and productive, based upon a shared understanding and alignment of decision-making preferences. Decision-making is most frequently undertaken as part of a collaborative shared style, showing ESP care is aligned to contemporary patient-centred and co-produced care.
Effective communication, an awareness and understanding of patient expectations and a combination of internal and external influences, including stress and anxiety, and other clinical and family relationships play an important role in decision- making. Patients lack awareness of the ESP role, however clearly placed trust in the ESP clinicians and were very satisfied with the care provided. Details of how ESPs consider the stresses and risks of their advanced roles have emerged, alongside ways in which these stresses may be managed. There is also insight into how ESP staff develop into their roles and consider the clinical competencies required to practice safely, transitioning from a traditional allied health professional role to that of an advanced practitioner.
Conclusion(s): Musculoskeletal ESPs and patients most frequently adopt a shared style of decision- making. Effective communication, clinical relationships, patient expectations and internal and external influences are the key factors impacting upon the decision-making process.
Implications: Increased understanding of the factors affecting patient consultations and decision- making has the potential to increase the effectiveness of advanced practice roles and provide more effective patient-centred care.
Understanding the risks and stresses associated with advanced practice roles could enable staff to identify and manage these issues more effectively reducing the potential risk of professional burnout.
Keywords: Musculoskeletal, Decision-making, Advanced practice
Funding acknowledgements: This work was supported by grants from the Chartered Society of Physiotherapy and the Advanced Practice Physiotherapy Network
Topic: Musculoskeletal; Service delivery/emerging roles; Professional issues
Ethics approval required: Yes
Institution: United Kingdom Integrated Research Application System
Ethics committee: Yorkshire and Humber Leeds West
Ethics number: 164795
All authors, affiliations and abstracts have been published as submitted.
