The patient experience of musculoskeletal imaging: a mixed methods study
Introduction: Musculoskeletal (MSK) imaging tests are used for diagnosis and management of arthritis. Although the technical and performance properties of conventional radiography (CR), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are well recognised, few studies have examined the patient experience of undergoing these tests. The aim of this study was to understand the patient experience of undergoing MSK imaging tests and to identify factors that contribute most to the patient experience. Methods: This study consisted of two stages. Stage one involved detailed semi-structured interviews with 33 patients with inflammatory arthritis who had undergone a recent joint CR, US, CT or MRI scan about their experience of the test. Interviews were transcribed and thematic analysis used to identify key themes. Stage two involved the generation of questionnaire items about MSK imaging from these interviews. Questionnaires were posted to 514 people with inflammatory arthritis who had undergone one of the four imaging modalities over a four month period. Respondents were asked to rate different aspects of the imaging tests on Likert scales. Variables associated with the overall patient experience of the test were analysed using linear regression models. Results: The interviews provided valuable information about the patient experience of MSK imaging. Patient knowledge about tests was informed by information they received from their doctor and their previous experience of imaging tests. Most patients were aware of potential harm from intravenous contrast or radiation. However, patients perceived imaging as part of standard clinical care and believed the benefits of tests outweighed the potential risks. Discomfort was described; both emotional discomfort due to claustrophobia and negative interactions with staff, and physical discomfort due to positioning. Some felt anxious waiting for tests or results. Viewing images resulted in improved understanding of disease and a sense of personal involvement in their arthritis treatment. There were 108 questionnaire respondents. Analysis of the questionnaire items showed that there were no significant differences in item answers for the four different imaging modalities. Multivariate linear regression identified five question items that were independently correlated with overall experience. Two items correlated positively (‘staff made the experience better’ and ‘part of usual care’) and two correlated negatively (‘discomfort during the test’ and ‘waiting for the test’). For those who saw their images ‘seeing improves understanding’ was positively independently associated with the overall experience. Conclusions: This study has identified factors before, during and after an MSK imaging test that contribute to the overall patient experience. Our findings show that MSK imaging tests are well tolerated by patients with arthritis who have a realistic perception of their value and potential risks. We recommend that patients having these tests are given sufficient information such as the approximate waiting time for their test and results and the potential risks of the test. The patient experience of MSK imaging for inflammatory arthritis could be optimised by ensuring positive interactions with radiology staff with careful consideration of patient comfort during the test, and viewing images with patients to improve their involvement in clinical care.
Advisor: Taylor, William; Dalbeth, Nicola
Degree Name: Master of Medical Science
Degree Discipline: Department of medicine
Publisher: University of Otago
Keywords: patient; experience; inflammatory; arthritis; musculoskeletal; imaging
Research Type: Thesis