ABSTRACT
BACKGROUND: Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health. OBJECTIVE: To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome. DESIGN: Qualitative study. PARTICIPANTS: Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general. APPROACH: Thematic analysis of in-depth interviews. RESULTS: Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution. CONCLUSIONS: Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.
Subject(s)
Communication Barriers , Communication , Physician-Patient Relations , Physicians, Family , Adult , Aged , Aged, 80 and over , Diagnosis , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND: The evidence for the effectiveness of reattribution training are limited, and optimal service delivery is not yet established. OBJECTIVES: The objectives of this study were to establish the feasibility and to optimize the service delivery and design of a definitive randomized controlled trial (RCT) of reattribution training for patients with medically unexplained symptoms (MUSs) in routine primary care. METHODOLOGY: The study was of a cluster RCT design with the practice as the unit of randomization. Health facilitator (HF)-delivered reattribution training was compared with no reattribution training. The primary outcome measure used is doctor-patient communication in the consultation. Quantitative and qualitative methods identify barriers to effectiveness. The acceptability and feasibility of the intervention were established by attendance rates and postal survey after completion of training. RESULTS: Sixteen practices and 70 family practitioners (FPs) were recruited with representative practice and FP characteristics. Six hours of HF reattribution training to FPs in the workplace proved feasible and acceptable with all 35 FPs completing the training. Feedback from 27 (77%) FPs who received training indicated that 25 (93%) FPs believed that specific and relevant learning achievements were made, 22 (82%) felt more confident and 21 (77%) thought the training was useful. CONCLUSION: HF-delivered reattribution training to whole practices is feasible and acceptable, and its effectiveness is measurable in routine primary care.
Subject(s)
Education, Medical, Continuing/standards , Family Practice/education , Inservice Training/standards , Mental Health Services/standards , Physician-Patient Relations , Somatoform Disorders/therapy , Adult , Communication , Education, Medical, Continuing/methods , Family Practice/standards , Feasibility Studies , Female , Humans , Inservice Training/methods , Male , Middle Aged , Program Evaluation , Reproducibility of Results , Somatoform Disorders/diagnosis , United Kingdom/epidemiologyABSTRACT
PURPOSE OF REVIEW: Increasingly, menopause research is using knowledge of psychological and social functioning to understand women's experiences of menopause and develop interventions to treat symptoms or reduce risk factors. Clinicians are more aware of the need to take account of psychological processes when discussing treatment choices, risks and quality of life. Here, we review the most recent developments in this area. RECENT FINDINGS: Group interventions based on a cognitive-behaviour therapy approach that address beliefs about symptoms and teach specific techniques (paced respiration) can reduce the frequency of hot flushes. Studies using a health education framework indicate that information is more salient for women when there are given feedback on their own higher osteoporosis risk status. Finally, there are promising signs that interventions to reduce risk factors can lead to sustained lifestyle change. SUMMARY: The increasing interest in psychological and social interventions is reflected in the number of new publications, but there are still too few large-scale well controlled studies. Earlier work on treatment decision making, and the factors predicting treatment choices has not been followed by larger studies. Reported research emphasizes the need for clinicians to assess women's beliefs about menopausal symptoms and use this knowledge to develop shared treatment plans.
