Analyzing physician /patient chronic pain communication through primary goals, secondary goals, stages of change and processes of change

Primary care office visits regarding chronic pain seldom lead to pain management strategies that improve health outcomes. A cycle of blame between physicians and patients often ensues: patients blame physicians for not taking away their pain and physicians blame patients for not taking a more active role in their pain management. Very little research has been conducted in the U.S. explicating the communication that occurs between primary care physicians and their patients who suffer from chronic pain. This study empirically identified the constructs of primary goals, secondary goals, stages of change and processes of change within twenty-one interactions between patients suffering from chronic pain and their primary care physicians. Interactions were transcribed and coded for the constructs under study. The twenty-one patients and twelve physicians also completed pre-visit and post-visit demographic and psychosociographic questionnaires. Additionally, patients were interviewed by phone four to six weeks following their visit to ascertain pain management adherence. Frequencies of talk that reflected primary goals, secondary goals, stages of change and processes of change are reported, most of which achieved adequate intercoder reliability (Neuendorf, 2002), indicating that the study constructs can be identified in live talk. Physicians’ secondary goals coding results produced two new secondary goals categories not identified in prior research. T-tests and correlations results that compared demographic and psychosociophraphic variables to frequencies are also reported. Small sample size limited interferential statistic results; however, power was adequate to find several statistically significant results with medium or large effect sizes. Notable findings included: patients’ and physicians’ self-reported primary goals were strongly correlated with their coded primary goals; the less time patients and physicians had been seeing one another the more often they used talk that reflected specific stages of change, processes of change and secondary goals; the more education patients had, the more likely they were to use talk that reflected specific stages of change and processes of change; and the less time physicians had been seeing patients, the more likely they were to use talk that specifically addressed their profession identities as knowledgeable physicians. Despite limitations largely due to small sample size, the results of this study lay groundwork for additional chronic pain communication research and provide hope that through a communication perspective we may help patients and physicians better negotiate plans for pain management