“MY IMPRESSION WAS I WAS BEING A NUISANCE”: IDENTITY AND LEGITIMACY IN REPEAT SPINE CONSULTATIONS

No conflicts of interest Source of funding: Lisa Osborn-Jenkins is funded by University Hospital Southampton NHS Foundation Trust (UHS) Research & Development PhD Fellowship [GRT0723] Purpose and background Self-management and behaviour change are integral to spine care. Despite the high-rate of recurrence and healthcare utilisation, clinical guidelines offer limited attention to repeat consultations. This project aimed to explore patients' reported experiences of return consultations and challenges of self-management for persistent or recurring back pain, to inform future delivery of self-management care. Methods and Results Twenty-one adults with persistent back pain who had returned to NHS primary care services on more than one recent occasion participated in online/in-person/telephone semi-structured interviews, according to preference. They shared their experience of self-management and reconsulting. Interviews were transcribed verbatim and analysed with reflexive thematic analysis. Patients' identity and legitimacy in repeat consultations was an important theme in the analysis, as participants perceived professional judgment about reattendance that extended beyond clinical assessment and impacted upon trust. Whilst some patients felt scrutinised or dismissed, others described the stabilising effect of being trusted by a familiar clinician. Portraying a determined and ‘keep going attitude’ was important to patients both within return consultations and in wider social contexts, as they experienced valued role loss, disrupted relationships and identity erosion Conclusion This novel study provides insight into the reported experiences of patients reconsulting within UK NHS services. It highlights concerns about legitimacy, identity and perceived judgement in return consultations, within a system that values self-management. Attending to patients' experience of credibility, trust and role disruption is key to legitimising and tailoring further supported self-management.