COMMUNICATION AND TREATMENT PREFERENCES AMONG OLDER ADULTS WITH CHRONIC MUSCULOSKELETAL PAIN

   Purpose: To investigate joint decision making perceptions and preferences among older adults with chronic musculoskeletal pain (MSP). 

   Method: Purposive sampling was used to identify a group of Hispanic and non-Hispanic White older adults (>55 years) with MSP from one outpatient practice and one senior center in New York City. Semi-structured interviews were completed with 53 individuals, transcribed and then analyzed using qualitative methods. Direct content analysis assessed: (a) contextual factors (i.e., specific modes of treatment) that prompt consultation, (b) patient-level characteristics (e.g., ethnicity, age) that influence the choice of consultant (e.g., family members, physician, friends), (c) reasons for not consulting others (e.g., self-reliance vs. no one to turn to) and (d) perceptions of the joint decision-making process (e.g., decisional conflict and satisfaction). Data acquisition continued until no new themes emerged indicating that thematic saturation had been reached.

   Result: With regard to contextual factors prompting consultation, participants undergoing invasive treatments (e.g., surgery) were most likely to seek advice and support from others. In addition, patients’ choice of consultant varied by individual-level factors (i.e., age and ethnicity). Whereas the oldest old (≥80) relied heavily on professional guidance and support from their close social network, younger participants more often engaged in self-initiated information-seeking and pain management strategies. In contrast with non-Hispanic Whites who primarily deferred to medical professionals for pain treatment, Hispanic participants often consulted relatives and close others for home remedies (e.g., ointments and creams) and alternative therapies (e.g., sobo). Importantly, cultural empathy played a key role in Hispanic participants’ interactions with health care providers. Physicians’ Spanish-language skills and cultural competency were vital to Hispanic patients' treatment and decision-making satisfaction. Regardless of sociodemographic background, individuals who engaged in meaningful dialogues expressed high levels of treatment satisfaction, especially when there was agreement among stakeholders.

   Conclusion: Our study provides insight into the contextual and personal factors that influence older adults’ communication patterns and desires to involve others in their pain care. Importantly, our findings offer valuable information for clinicians. In particular, results reveal the importance of fostering empathic and culturally sensitive patient-provider exchanges across diverse patient populations. More broadly, our findings indicate that social networks beyond the patient-physician dyad may influence patients’ treatment and decision satisfaction.