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Do photographic images of pain improve communication during pain consultations?

Padfield D, Zakrzewska JM, Williams AC - Pain Res Manag (2015 May-Jun)

Bottom Line: Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images.Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction.These findings will inform future analysis of behaviour in the video-recorded consultations.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Visual images may facilitate the communication of pain during consultations.

Objectives: To assess whether photographic images of pain enrich the content and⁄or process of pain consultation by comparing patients' and clinicians' ratings of the consultation experience.

Methods: Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation.

Results: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients' and clinicians' ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients' and clinicians' expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance.

Conclusions: Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video-recorded consultations.

No MeSH data available.


AImage of pain co-created by Deborah Padfield with Chandrakant Khoda from the series Face2Face © Deborah Padfield;BImage of pain cocreated by Deborah Padfield with Linda Sinfield from the series Perceptions of Pain © Deborah Padfield;CImage of pain co-created by Deborah Padfield with Alison Glenn from the series Face2Face © Deborah Padfield;DImage of pain co-created by Deborah Padfield with Liz Aldous from the series Face2Face © Deborah Padfield;EImage of pain co-created by Deborah Padfield with John Pates from the series Perceptions of Pain © Deborah Padfield
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f1-prm-20-123: AImage of pain co-created by Deborah Padfield with Chandrakant Khoda from the series Face2Face © Deborah Padfield;BImage of pain cocreated by Deborah Padfield with Linda Sinfield from the series Perceptions of Pain © Deborah Padfield;CImage of pain co-created by Deborah Padfield with Alison Glenn from the series Face2Face © Deborah Padfield;DImage of pain co-created by Deborah Padfield with Liz Aldous from the series Face2Face © Deborah Padfield;EImage of pain co-created by Deborah Padfield with John Pates from the series Perceptions of Pain © Deborah Padfield

Mentions: Photographs were co-created by the first author (DP) with patients on the waiting list for treatment for varied chronic facial pain; the methodology is described in Padfield (26,32). Photographs taken by the artist in collaboration with the individual experiencing pain were subsequently reviewed on a computer, and the patient and artist selected some images for modification, again as a collaboration, to express as clearly as possible the patient’s experience of her or his pain. A selection of these photographs was integrated with a selection of images from an earlier project (produced with patients experiencing musculoskeletal pain [2,33]) to create a set of 54 ‘pain cards’. Selection for the final set was made using data from the earlier study, patient and public responses from exhibitions in hospitals and galleries, and in consultation with clinicians. The images were reproduced as laminated pain cards measuring 142 mm × 105 mm so that they could be easily handled without damage. Predominantly, the photographs feature objects as metaphors for pain (eg, sparks between electrical wires, or hot or sharp materials or objects; Figures 1A, 1B and 1C); several depict pain located on the body; and some are more symbolic, abstract and ambiguous, enabling projection of varied emotions onto the image, which would not necessarily be the same for any two viewers. Some images were both metaphorical and abstract; even apparently literal images, such as barbed wire, can have associations such as torture (Amnesty International logo, www.amnesty.org.uk/) that may be conveyed intentionally or unintentionally as part of the experience of pain (Figure 1B).


Do photographic images of pain improve communication during pain consultations?

Padfield D, Zakrzewska JM, Williams AC - Pain Res Manag (2015 May-Jun)

AImage of pain co-created by Deborah Padfield with Chandrakant Khoda from the series Face2Face © Deborah Padfield;BImage of pain cocreated by Deborah Padfield with Linda Sinfield from the series Perceptions of Pain © Deborah Padfield;CImage of pain co-created by Deborah Padfield with Alison Glenn from the series Face2Face © Deborah Padfield;DImage of pain co-created by Deborah Padfield with Liz Aldous from the series Face2Face © Deborah Padfield;EImage of pain co-created by Deborah Padfield with John Pates from the series Perceptions of Pain © Deborah Padfield
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4447153&req=5

f1-prm-20-123: AImage of pain co-created by Deborah Padfield with Chandrakant Khoda from the series Face2Face © Deborah Padfield;BImage of pain cocreated by Deborah Padfield with Linda Sinfield from the series Perceptions of Pain © Deborah Padfield;CImage of pain co-created by Deborah Padfield with Alison Glenn from the series Face2Face © Deborah Padfield;DImage of pain co-created by Deborah Padfield with Liz Aldous from the series Face2Face © Deborah Padfield;EImage of pain co-created by Deborah Padfield with John Pates from the series Perceptions of Pain © Deborah Padfield
Mentions: Photographs were co-created by the first author (DP) with patients on the waiting list for treatment for varied chronic facial pain; the methodology is described in Padfield (26,32). Photographs taken by the artist in collaboration with the individual experiencing pain were subsequently reviewed on a computer, and the patient and artist selected some images for modification, again as a collaboration, to express as clearly as possible the patient’s experience of her or his pain. A selection of these photographs was integrated with a selection of images from an earlier project (produced with patients experiencing musculoskeletal pain [2,33]) to create a set of 54 ‘pain cards’. Selection for the final set was made using data from the earlier study, patient and public responses from exhibitions in hospitals and galleries, and in consultation with clinicians. The images were reproduced as laminated pain cards measuring 142 mm × 105 mm so that they could be easily handled without damage. Predominantly, the photographs feature objects as metaphors for pain (eg, sparks between electrical wires, or hot or sharp materials or objects; Figures 1A, 1B and 1C); several depict pain located on the body; and some are more symbolic, abstract and ambiguous, enabling projection of varied emotions onto the image, which would not necessarily be the same for any two viewers. Some images were both metaphorical and abstract; even apparently literal images, such as barbed wire, can have associations such as torture (Amnesty International logo, www.amnesty.org.uk/) that may be conveyed intentionally or unintentionally as part of the experience of pain (Figure 1B).

Bottom Line: Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images.Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction.These findings will inform future analysis of behaviour in the video-recorded consultations.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Visual images may facilitate the communication of pain during consultations.

Objectives: To assess whether photographic images of pain enrich the content and⁄or process of pain consultation by comparing patients' and clinicians' ratings of the consultation experience.

Methods: Photographic images of pain previously co-created by patients with a photographer were provided to new patients attending pain clinic consultations. Seventeen patients selected and used images that best expressed their pain and were compared with 21 patients who were not shown images. Ten clinicians conducted assessments in each condition. After consultation, patients and clinicians completed ratings of aspects of communication and, when images were used, how they influenced the consultation.

Results: The majority of both patients and clinicians reported that images enhanced the consultation. Ratings of communication were generally high, with no differences between those with and without images (with the exception of confidence in treatment plan, which was rated more highly in the image group). However, patients' and clinicians' ratings of communication were inversely related only in consultations with images. Methodological shortcomings may underlie the present findings of no difference. It is also possible that using images raised patients' and clinicians' expectations and encouraged emotional disclosure, in response to which clinicians were dissatisfied with their performance.

Conclusions: Using images in clinical encounters did not have a negative impact on the consultation, nor did it improve communication or satisfaction. These findings will inform future analysis of behaviour in the video-recorded consultations.

No MeSH data available.