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Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study.

ABSTRACT: BACKGROUND:Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs' difficulties in communication during MUS consultations. METHODS:We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We selected the comments where GPs experienced difficulties or indicated they should have done something else and analysed these qualitatively according to the principles of constant comparative analysis. Next, we selected those video-recorded transcripts in which the patient also experienced difficulties; we analysed these to identify problems in the physician-patient communication. RESULTS:Twenty GPs participated, of whom two did not identify any MUS consultations. Eighteen GPs commented on 39 MUS consultations. In 11 consultations, GPs did not experience any difficulties. In the remaining 28 consultations, GPs provided 84 comments on 60 fragments where they experienced difficulties. We identified three issues for improvement in the GPs' communication: psychosocial exploration, structure of the consultation (more attention to summaries, shared agenda setting) and person-centredness (more attention to the reason for the appointment, the patient's story, the quality of the contact and sharing decisions). Analysis of the patients' views on the fragments where the GP experienced difficulties showed that in the majority of these fragments (n =?42) the patients' comments were positive. The video-recorded transcripts (n =?9) where the patient experienced problems too were characterised by the absence of a dialogue (the GP being engaged in exploring his/her own concepts, asking closed questions and interrupting the patient). CONCLUSION:GPs were aware of the importance of good communication. According to them, they could improve their communication further by paying more attention to psychosocial exploration, the structure of the consultation and communicating in a more person-centred way. The transcripts where the patient experienced problems too, were characterised by an absence of dialogue (focussing on his/her own concept, asking closed questions and frequently interrupting the patient).

SUBMITTER: Houwen J

PROVIDER: S-EPMC6935475 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study.

Houwen Juul J Lucassen Peter L B J PLBJ Verwiel Anna A Stappers Hugo W HW Assendelft Willem J J WJJ Olde Hartman Tim C TC van Dulmen Sandra S

BMC family practice 20191229 1

<h4>Background</h4>Many general practitioners (GPs) struggle with the communication with patients with medically unexplained symptoms (MUS). This study aims to identify GPs' difficulties in communication during MUS consultations.<h4>Methods</h4>We video-recorded consultations and asked GPs immediately after the consultation whether MUS were presented. GPs and patients were then asked to reflect separately on the consultation in a semi-structured interview while watching the consultation. We sele ...[more]

PMID: 31884966

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Project description:BACKGROUND:It is unknown whether patients with medically unexplained symptoms (MUS) differ from patients with medically explained symptoms (MES) regarding their expectations and experiences on task-oriented communication (ie, communication in which the primary focus is on exchanging medical content), affect-oriented communication (ie, communication in which the primary focus is on the emotional aspects of the interaction) and therapy-oriented communication (ie, communication in which the primary focus is on therapeutic aspects) of the consultation and the extent to which GPs meet their expectations. OBJECTIVE:This study aims to explore (a) differences in patients' expectations and experiences in consultations with MUS patients and patients with MES and (b) the influence of patients' experiences in these consultations on their post-visit anxiety level. STUDY DESIGN:Prospective cohort. SETTING:Eleven Dutch general practices. MEASUREMENTS:Patients completed the QUOTE-COMM (Quality Of communication Through the patients' Eyes) questionnaire before and after the consultation to assess their expectations and experiences and these were related to changes in patients' state anxiety (abbreviated State-Trait Anxiety Inventory; STAI). RESULTS:Expectations did not differ between patients with MUS and MES. Patients presenting with either MUS or MES rated their experiences for task-related and affect-oriented communication of their GP higher than their expectations. GPs met patients' expectations less often on task-oriented communication in MUS patients compared to MES patients (70.2% vs 80.9%; P = ?0.001). Affect-oriented communication seems to be most important in reducing the anxiety level of MUS patients (? -0.63, 95% Cl = -1.07 to -0.19). DISCUSSION:Although the expectations of MUS patients are less often met compared to those of MES patients, GPs often communicate according to patients' expectations. Experiencing affect-oriented communication is associated with a stronger reduction in anxiety in patients with MUS than in those with MES. CONCLUSION:GPs communicate according to patients' expectations. However, GPs met patients' expectations on task-oriented communication less often in patients with MUS compared to patients with MES. Experiencing affect-oriented communication had a stronger association with the post-consultation anxiety for patients with MUS than MES.

Project description:BackgroundMedically unexplained physical symptoms (MUPS) are a substantial health problem in primary care with a high burden for patients, general practitioners, and the health care system. Most studies focus on chronic MUPS patients. Little research is conducted in patients with moderate MUPS, and an effective primary care intervention for prevention of chronic MUPS is lacking.ObjectiveThe objective of our study was to identify treatment modalities based on expert opinions for the development of a multidisciplinary and blended intervention for patients with moderate MUPS to prevent chronicity.MethodsTwo focus groups with 8 and 6 experts (general practitioners, physical therapists, psychologists, and mental health nurses) were carried out. The focus groups were structured using the nominal group technique.ResultsA total of 70 ideas were generated from two nominal group meetings, and 37 of these got votes, were included in the rank order, and were sorted into 8 separate themes. According to the participants, the most important treatment modalities for a multidisciplinary and blended intervention in patients with moderate MUPS were (1) coaching to a healthier lifestyle, (2) education regarding psychosocial factors, (3) therapeutic neuroscience education, (4) multidisciplinary intake, (5) multidisciplinary cooperation and coordination, (6) relaxation or body awareness exercises, (7) clear communication by professionals to the patient, and (8) graded activity. Five independent researchers checked the ideas and linked them to themes to confirm the content analysis and check the validity of the themes.ConclusionsFrom professional expert perspectives, 8 themes should be included in a multidisciplinary and blended intervention to prevent chronicity. These themes provide a first step in developing an intervention for patients with moderate MUPS. Future research should focus on further development steps in which patients with moderate MUPS should be involved to determine if the intervention matches their needs.

Dataset Information

Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study.

Publications

Which difficulties do GPs experience in consultations with patients with unexplained symptoms: a qualitative study.

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