"I hope to get some hope": balancing expectations, hope, and acceptance in naturally occurring consultations without a medical diagnosis.

Background: Chronic musculoskeletal pain (CMP) is a prevalent condition often lacking clear biomedical explanations, leading to frustration for both clinicians and patients. The uncertainty surrounding CMP deeply affects the dynamics of clinical consultations.

Aim: This study investigates how clinicians and patients navigate expectations and uncertainty in CMP consultations, focusing on the interplay between hope and acceptance.

Methods: Nineteen naturally occurring consultations were observed and post-consultation interviews conducted with both patients and clinicians. Data were analysed using reflexive thematic analysis and presented through four individual consultations.

Results: The study identified three main themes: expectations, hope, and acceptance. Patients frequently expressed hope for a diagnosis and treatment, while clinicians sought to guide them towards acceptance of their condition and managing symptoms rather than seeking a cure. However, patients often struggled with this approach, viewing it as a loss of hope for improvement. Additionally, patients' cultural expectations of biomedical solutions affected their response to acceptance-focused communication. The study highlights the tension between encouraging acceptance and maintaining hope.

Conclusion: The findings underscore the need for more nuanced communication strategies that strikes the right balance between fostering hope and acceptance, while acknowledging the cultural expectations of biomedical solutions that patients bring into the consultation room.