Table 2.

Summary of papers identified exploring consultation experiences in OA

First author, year, country	Participants 1	Methods 2	Aim	Extracted findings relating to consultation experience and/or GPs attitudes and beliefs	Comments and limitations
Alami (2011),France [24]	81 patients, 11 GPs, 6 Rheum, 4 Orth, 4 Alt Med	Interviews	To explore views on management and barriers to improvement	Patients report importance of doctor patient relationship and various barriers to treatment including side effects, fear of addiction, fear of masking pain, and a wish to focus on preventative options. GP’s report range of attitudes including the belief that OA is not a disease. Some patients and GPs identified OA as an area of uncertainty for GPs.	Not always clear which results (health care practitioners) pertained to GPs. No findings in results to support author claims in abstract and conclusion that patients feel they are not taken seriously and that GPs act as ‘technicians’; findings do not entirely match authors’ conclusions.
Busby (1997), UK [18]	80 patients, 3 GPs, 1 Rheum	Interviews fieldwork	To understand perceptions and experiences of OA	Patients describe multiple attempts at seeking healthcare, explanations couched in terms of ageing meant OA was inevitable and that nothing could be done. GPs report lack of therapeutic options threatening doctor-patient relationship.	Results in book chapter. Authors’ report findings from GPs don’t constitute ‘a systematic study’. 80 patients but only 7 cited in findings. No reported analysis methods.
Coar (2004), UK [23]	9 GPs, 3 Physio, 3 Rheum	Interviews	To explore GP’s beliefs and attitudes regarding OA	Diagnosis and use of ‘wear and tear’ emergent themes. Use of ‘wear and tear’ perceived as acceptable and useful given lack of alternative terms. Evidence of practitioners playing down severity.	MPhil thesis. Author (GP) reports on limitations and influence of interviewing their peers.
Davis (2004), USA [34]	57 Patients	Focus groups	To explore barriers to chronic pain management in arthritis	In the theme ‘relationship with healthcare providers’, patients describe unwelcome focus on prescriptions, and miscommunication in the consultation.	Small part of results relevant to this review; ‘Relationship with healthcare providers’ was one of nine emergent barriers to pain management
De Bock (1992), Netherlands [35]	14 GPs	Interviews [Medical record review]	To explore GP’s ‘policy’ in managing OA	Marked variance in the perceived importance and management of OA. Authors conclude consensus needed	Small part of results relevant to this review; small focus on interview findings in results. Little information on analysis of qualitative data.
Gignac (2006), Canada [17]	53 patients	Focus groups	To compare health experiences of middle aged and older adults with OA	Patients reported being told OA was normal for age, going to get worse, and were encouraged to accept their symptoms. Conversely, patients felt they had more control over the trajectory of OA. Delays in diagnosis reported and insufficient communication around prescriptions	Study design included ‘control’ focus groups which did not appear to add to conclusions or findings.
Glauser (2011), USA [33]	152 GPs, 99 NP & PAs	[Vignettes] survey	To examine the knowledge, attitudes and beliefs and practice of GPs regarding management of OA	Most common educational need identified in free text part of survey was around treatment	Small part of results relevant to this review; methods state researchers elicited barriers to care and confidence in managing OA, but only vignette results and educational needs reported in results. As a result, results mainly address ‘practice’ aspect of study aim.
Grime (2010), UK [22]	27 patients	Interviews	To explore perceptions of wellness in elderly people with OA	Reports both discordance and acceptance of ‘wear and tear’ used in diagnosis	Small part of results relevant to this review; most of the results relate to everyday activities and not consulting with a doctor.
Hill (2010), UK [29]	29 patients	Focus groups	To explore perceptions and experience of treatment and management of hand OA	Patients described dissatisfaction with amount of information, feeling that ‘nothing can be done’, and held perceptions that GPs lacked understanding of the impact of hand OA. Authors conclude some of the findings imply lack of knowledge of treatment options.	Sample included 14 patients from secondary care, and not always clear which setting consultation experiences related to.
Jinks (2007), UK [20]	22 patients	Survey interviews	To investigate population and individual needs assessment	Patients report being told their pain is ‘wear and tear’, related to age, to ‘live with it’ and that nothing can be done. Patients also held the view nothing could be done.	Small part of results relevant to this review; most of the results relate to living with knee pain. Patients were > 50 years and had self-reported knee pain, and may not all have had OA.
Kee (1998), USA [37]	20 patients	Interviews	To gain an ‘insider view’ of living with OA	The theme ‘staying in charge’ describes patients’ lack of adherence with GP recommended interventions, with examples of miscommunication.	Small part of results relevant to this review; most of the results relate to living with OA.
Kingsbury (2012), UK [31]	232 GPs	Survey	To identify GP reported management of OA	GPs described barriers to effective OA management including inability to manage pain adequately, time in the consultation and enabling patients to make lifestyle changes.	Small part of results relevant to this review; most of the findings relate to self-reported GP behaviours. Low response rate
Lambert (2000), USA [28]	12 patients, 14 Doctors (including GPs, rheum and others)	Focus groups	To understand views and experience of OA care and expressed needs	Patients value ‘low-tech’ treatments with doctors tending to value medicines and surgery. Doctors report OA as being related to ageing, which patients report as difficult to accept. Doctors reported lack of musculoskeletal training as an issue, and specific educational needs were identified.	Authors do not specify number of GPs, and sample includes other secondary care doctors; not clear which findings relate to GPs.
Mann (2011), UK [16]	16 patients, 2 GPs, 1 Rheum, 1 OT, 2 Physio, 4 NPs	Focus groups and interviews	To explore views on provision of care and possible improvements	Patients reported delays in diagnosis, a feeling that ‘nothing was done’, and difficulty knowing when to return to the doctor. Patients reported OA was not a priority and health professionals reported lack of time as an issue. A GP participant reported not perceiving a need for patient information, although the HP as a whole identified a need for more information	Only 2 GP participants.
McHugh (2007), UK [27]	21 Patients	Semi-structured interviews	To investigate the experiences of patients on the waiting list for joint replacement	Patients reported hiding their symptoms from their GP after previous negative experiences.	Small part of results relevant to this review; much of the results about living with OA and self-management etc.
Pitt (2008), Australia [36]	13 GPs	Focus groups semi-structured interviews	To explore enablers and barriers to referring patients with OA to self-management programmes	A range of referral patterns and attitudes to self-management in OA were uncovered. Barriers to referral included GPs holding the belief that OA was different to other chronic diseases and time in the consultation	Small part of results relevant to this review; attitudes to OA not primary objective of researchers, and so attitudes elicited were only those of relevance to self-management programme referral. Small sample.
Rosemann (2006), Germany [32]	20 patients 20 GPs, 20 NPs	Interviews	To identify health care needs and obstacles for improvements	Patients reported pain and fear of disability as their most important concerns that were inadequately addressed in the consultation, with insufficient information about prognosis. Doctors reported resource issues as barrier to effective treatment, while patients reported communication deficits.	Issues of transferability due to healthcare funding in Germany which reportedly does not ‘value’ conservative treatments equally with non-conservative, and due to large number of non-surgical orthopaedic specialists working in primary care. More findings reported from GPs than patients.
Sanders (2002), UK [19]	27 patients	Interviews	To examine the meanings of symptoms of OA	Delays in diagnosis reported. Older participants reported down-playing symptoms.	Small part of results relevant to this review; paper concerns general experience of living with OA.
Sanders (2004), UK [25]	27 patients	Interviews	To explore barriers to joint replacement	Participants describe being told nothing can be done; often those who asked about surgery reported being told they were unsuitable for various reasons, including age, by their GP	Small part of results relevant to this review; data extracted from one of 3 themes relating to experiences of primary care.
Thomas (2013), UK [30]	11 patients	Semi structured interviews	To describe patient experience of seeing their GP with foot OA	Patients described being given little information, felt foot OA was low priority, and felt there was an ‘unwelcome focus on drugs’.	Conference Proceeding, and therefore limited information on findings
Turner (2007), UK [26]	31 patients	Interviews	To investigate beliefs about causes of OA	‘Overwhelming majority’ reported no negative psychological reaction to diagnosis. Some patients reported that GPs had reinforced the belief that OA would deteriorate over time.	Small part of results relevant to this review, around the theme of diagnosis.
Victor (2004), UK [21]	170 patients	Interviews [Patient diaries, Group sessions]	To explore patients’ perspective on meaning and significance of OA	Participants reported a lack of information that had been given by GPs previously and uncertainty about the nature, self-management and outcomes of OA.	Small part of results relevant to this review; research conducted in the context of a randomised controlled trial therefore only data relating to participants' previous interaction with healthcare was extracted.

¹Alt Med: GP specialising in alternative medicine; HP: Health professional; NP: Nurse Practitioner or practice nurse; Orth: Orthopaedic Surgeon; PA: Physician assistant; OT: Occupational Therapist; Physio: Physiotherapist; Rheum: Rheumatologist.

²Methods in square brackets yielded data that was not extracted for the purposes of this review.