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Shared decision making in musculoskeletal pain consultations in low- and middle-income countries: a systematic review.

Authors
  • Sam, Sreya1
  • Sharma, Radha1
  • Corp, Nadia2
  • Igwesi-Chidobe, Chinonso2
  • Babatunde, Opeyemi O2
  • 1 University School of Medicine, Keele University, Staffordshire ST5 5BG, UK.
  • 2 Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire ST5 5BG, UK.
Type
Published Article
Journal
International health
Publication Date
Sep 01, 2020
Volume
12
Issue
5
Pages
455–471
Identifiers
DOI: 10.1093/inthealth/ihz077
PMID: 31728513
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Global populations, especially those in low- and middle-income countries (LMICs), are at an increased risk of musculoskeletal (MSK) pain, a leading cause of years lived with disability. Shared decision making (SDM) in the management of these conditions may drive improvements in healthcare outcomes and quality. This study aimed to synthesize and appraise available evidence regarding SDM in MSK pain consultations in LMICs. Comprehensive literature searches were conducted in 12 databases for primary studies investigating SDM in MSK pain consultations across all healthcare and community settings in LMICs. Study eligibility screening, data extraction and quality appraisal (using the Critical Appraisals Skills Programme tool) were completed by pairs of reviewers. Findings were brought together using thematic synthesis of data from all the primary studies. Seven studies (mostly moderate quality) were included. There was low awareness of SDM among healthcare professionals (HCPs); however, this is not explicitly practised due to cultural and operational barriers. HCP training and patient empowerment through health literacy were proposed facilitators. The traditional paternalistic approach to treatment poses a key barrier to SDM, decreases adherence to prescribed treatments and raises the risk of poor clinical outcomes. SDM is still a relatively 'foreign concept' within consultations and management of MSK pain patients in LMICs. There is a dearth of research in SDM and patient-centred care. Given the socio-economic impact of MSK pain, further research into the value of SDM in LMIC healthcare settings requires further consideration. © The Author(s) 2019. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

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