'When the picture does not really tell the story'- A qualitative exploration of the MRI report of findings as a means for generating shared diagnostic meaning during the management of patients suffering from persistent spinal pain

Abstract

Objectives: To explore the magnetic resonance imaging (MRI) feedback report as a health care encounter for generating shared diagnostic meaning.

Methods: An exploratory, qualitative case study was conducted using video observation of the MRI report of findings, individual face-to-face and telephonic interviews.

Results: From fourteen distinct encounters, three key themes emerged, these being: 'a powerful shared experience, 'a legacy of biomedical thinking' and 'clinical practice quandaries'. Generally speaking, the MRI encounter was observed to be both an effective and satisfying method for developing shared diagnostic meaning. However, in instances where a structure-based diagnosis could not be reasonably established, clinicians experienced doubts in what to present in a 'soft report'. A feature of these was the communication of speculative causal feedback, based on non-visualised structures and/or incidental findings observed.

Conclusion: Shared diagnostic meaning can result from a 'soft' MRI report of findings. However, the emergence of diagnostic closure is not guaranteed. Further exploration of this phenomenon in the context of shared decision making and the therapeutic alliance is warranted.

Practice implications: Pre-feedback peer conferences might be considered in order to standardise the information communicated to patients. Clinicians might also consider limiting the MRI scan as a visual aid in 'soft' reports.

Keywords: Chronic back pain; Clinician experience; Decisional conflict; Diagnostic closure; MRI; Patient experience; Qualitative; Shared decision making; Therapeutic alliance.