Everyday Life, Healthcare, and Self-Care Management Among People With Irritable Bowel Syndrome: An Integrative Review of Qualitative Research

Understanding Gut Sensations: Irritable Bowel Syndrome and Diagnostic Fluidity in Danish Clinical Practice

Irritable bowel syndrome (IBS) is a prevalent health challenge in a Danish welfare context. Drawing on ethnographic fieldwork at two Danish gastroenterology clinics, and inspired by Charles E. Rosenberg's idea of styles of explaining widespread diseases, we outline three styles of understanding and treating gut trouble in daily clinical work: "The microbial gut," "the mindful gut," and "the lifestyled gut." Moreover, we suggest the concept of fluidity to characterize IBS as a diagnostic category that allows clinicians and patients to operate through complex understandings of permeable boundaries between body, mind, and environment to negotiate personalized solutions for embodied gut sensations.

Shared decision-making improving efficacy in diarrhoea-dominant irritable bowel syndrome in Chinese outpatient setting: protocol of a prospective, randomised controlled trial

INTRODUCTION

Diarrhoea-dominant irritable bowel syndrome (IBS-D) is a disorder with multiple pathogenesis; many people with IBS-D may have psychosocial issues which can make assessment and treatment more difficult. Routine treatment procedure might not always achieve the desired outcome. Therefore, patients may not be satisfied with the conventional experience and would like to be more involved in clinical decision-making. A shared decision-making (SDM) model, that requires patient participation, has been demonstrated to have a powerful effect on the diagnosis and treatment of other diseases, which improves patients' compliance, satisfaction, thus refining the clinical outcome. However, there is no corresponding evidence in IBS-D. Herein, we hope to verify the effect of SDM through clinical studies, and we anticipate that SDM can improve the therapeutic effect in patients with IBS-D.

METHODS

The study is a prospective, randomised, single-centre trial. 166 IBS-D outpatients who attend Peking Union Medical College Hospital will be allocated into routine treatment group and SDM group. The primary endpoint is the severity of bowel symptoms, measured by the IBS symptom severity scale. Secondary endpoints include impact of disease and quality of life, negative psychology and the evaluation of diagnosis and treatment process.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the research ethics committee of Peking Union Medical College Hospital (I-23PJ470). This protocol has been approved by Chinese Clinical Trial Register (ChiCTR2300073681) in July 2023. The results of this trial will be published in an open-access way and disseminated among gastrointestinal physicians.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Register (ChiCTR2300073681).

Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China

AIM

To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China.

METHODS

We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory.

RESULTS

We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life.

CONCLUSION

Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.

"You have to trust yourself": The Overlooked Role of Self-Trust in Coping with Chronic Illness

Self-trust is essential to the well-being of people with chronic illnesses and those who care for them. In this exploratory essay, we draw on a trove of health narratives to catalyze examination of this important but often overlooked topic. We explore how self-trust is impeded at both personal and structural levels, how it can best be nourished, and how it is related to self-advocacy. Because people's ability to trust themselves is intrinsically linked to the trust others have in them, we pay particular attention to the role that allies such as clinical professionals play in the development of self-trust, highlighting the importance of eliciting patient narratives, of curious listening, and of compassionately raising questions. We also contrast the self-trust paradigm with that of self-management, which tends to replace the former's attention to patients' experiences, abilities, qualities, or judgments with a professionally dominated discourse dedicated to addressing illness through behavior changes prescribed by clinicians. We close with a call to action, exhorting readers to focus on supporting self-trust in health care settings and on creative research in this critical yet heretofore underrepresented domain.

Functional gastrointestinal symptoms and increased risk for orthorexia nervosa

PURPOSE

Recent guidelines point out the possible risk for orthorexia nervosa in functional gastrointestinal disorders, however, to date, no study has investigated this association. The present study aimed to explore the potential relationship between irritable bowel syndrome-related functional gastrointestinal symptoms and certain maladaptive eating behaviours, such as symptoms of orthorexia nervosa and emotional eating.

METHODS

A sample of 644 Hungarian volunteers (M_age = 22.37; SD_age = 3.95) completed a survey with the following questionnaires: the Rome IV Diagnostic Questionnaire (R4DQ) for adults-Irritable bowel syndrome module for the measurement of functional gastrointestinal symptoms, the Hungarian version of the ORTO-15 questionnaire (ORTO-11-Hu) to assess symptoms of orthorexia nervosa, the Three-Factor Eating Questionnaire (TFEQ) Emotional Eating subscale to measure symptoms of emotional eating and the Short Health Anxiety Inventory (SHAI) for the assessment of health anxiety. Spearman's rank correlation was used to explore the associations between the measured variables, and structural equation modeling was used to test the proposed mediation models.

RESULTS

Functional gastrointestinal symptoms were positively related to symptoms of orthorexia nervosa and emotional eating. The relationship between functional gastrointestinal symptoms and symptoms of orthorexia nervosa was partially mediated by health anxiety, while the association between functional gastrointestinal symptoms and symptoms of emotional eating was partially mediated by symptoms of orthorexia nervosa.

CONCLUSION

Our findings highlight the possible risk for developing orthorexic symptoms in functional gastrointestinal symptoms, which could lead to other types of disordered eating patterns, such as emotional eating. The results also underscore the potential role of health anxiety in these relationships.

LEVEL OF EVIDENCE

Level V (descriptive cross-sectional study).

Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB

OBJECTIVES

To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers.

METHODS

A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model.

RESULTS

A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers.

CONCLUSIONS

The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.

Creation of a Multispecialty Clinic for Patients with Central Sensitization-Based Chronic Pain Conditions

Objective

To design and evaluate, through a human-centered design approach, a multispeciality clinic for patients with central sensitization syndromes that combined virtual previsit consultations, traditional face-to-face appointments, and technology-enabled educational programming.

Patients and Methods

Patients with suspected fibromyalgia and chronic abdominal pain were seen in a multispecialty practice, and the performance of the clinic was evaluated against a contemporary cohort. Quantitative and qualitative evaluation measures included team estimates of time spent on care-related tasks, physician rank of alignment of patient need with clinic design, major appointment changes, and nonvisit care tasks. Members of the care team also evaluated strengths, weaknesses, opportunities, and threats to the success of the clinic.

Results

The pilot clinic was operated from April 1, 2020, to April 30, 2021, and included 34 patients with suspected fibromyalgia/chronic abdominal pain. During the pilot period, physicians ranked the value of the virtual previsit consultations in providing care as 7.5 on a scale of 0 to 10 and reported an average of 50 minutes in preparation for the appointment, execution of the appointment, and postvisit documentation. We did not observe substantial differences in the number of added appointments or messages received within the patient portal when compared with a comparison cohort. Patients who participated in the combination nurse educator–led and digital education program provided positive feedback about their experience.

Conclusion

Our clinic model provides a framework for the treatment of patients with debilitating centrally sensitized conditions and future expansion of virtual care delivery models to better meet patient care and educational needs.

Alien Guts? Exploring Lives of and with Irritable Bowels in Denmark

Irritable bowel syndrome (IBS) is a health challenge in Denmark, especially among young and middle-aged people. It raises questions about control, alienation, responsiveness, and responsibility in relation to the body in welfare societies. Based on long-term ethnographic fieldwork, this article explores how young and middle-aged Danes diagnosed with IBS inhabit and relate to their bodies. Previous studies have described how IBS patients experience their bodies to be unreliable, unpredictable, and embarrassing. Drawing on phenomenological explorations of bodily alterity, we argue that the gut transforms into "an other" for the afflicted. It is involved in a restless process in which it sometimes emerges as "me," sometimes as "not-me," and sometimes as "not-not-me." People attempt to theorize and control their gut trouble, yet it continuously escapes their grasp. How do people live with and care for such an alienness-within? Does an IBS diagnosis make bodies feel more or less alien?

Central Sensitization Symptom Severity and Patient-Provider Relationships in a Community Setting

Introduction

Central sensitization syndromes (CSS) comprise an overlapping group of clinical conditions with the core feature of “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Patients with CSS are known to have challenging interactions with healthcare providers contributing to psychological distress and increased healthcare utilization. CSS symptom severity has been associated with psychologic comorbidities, but little is known about how symptom severity relates to provider interactions.

Methods

We performed a cross-sectional survey among patients with CSS in our primary care practices to examine the relationship between CSS symptom severity and experiences with doctors.

Results

A total of 775 respondents completed the survey (775/5000; 15.5%) with 72% reporting high CSS symptom severity. About 44% of respondents had a prior diagnosis of fibromyalgia, 72% had migraines, and 28% had IBS. Patients with high CSS symptom severity were more likely to report that doctor(s) had often/always told them that they don’t need treatment when they feel like they do (OR = 3.6, 95% CI 1.9-7.5), that doctor(s) often/always don’t understand them (OR = 3.1, 95% CI 1.9-5.4), and that doctor(s) often/always seem annoyed with them when compared with respondents with low-moderate CSS symptom severity (OR = 4.8, 95% CI 2.2-12.5). Patients with high CSS symptom severity were at greater than 5 times odds of reporting being told that their symptoms were “all in their head” when compared to patients with low-moderate symptom severity (OR = 5.4, 95% CI 3.3-9.0).

Conclusion

Patients with CSS spectrum disorders experience frequent pain and decreased quality of life. A high degree of CSS symptom severity is associated with negative experiences with healthcare providers, which deters the establishment of a positive provider-patient relationship. Further research is needed to help understand symptom severity in CSS and harness the power of the therapeutic alliance as a treatment modality.

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

Irritable bowel syndrome (IBS) remains one of the most common gastrointestinal disorders seen by clinicians in both primary and secondary care. Since publication of the last British Society of Gastroenterology (BSG) guideline in 2007, substantial advances have been made in understanding its complex pathophysiology, resulting in its re-classification as a disorder of gut-brain interaction, rather than a functional gastrointestinal disorder. Moreover, there has been a considerable amount of new evidence published concerning the diagnosis, investigation and management of IBS. The primary aim of this guideline, commissioned by the BSG, is to review and summarise the current evidence to inform and guide clinical practice, by providing a practical framework for evidence-based management of patients. One of the strengths of this guideline is that the recommendations for treatment are based on evidence derived from a comprehensive search of the medical literature, which was used to inform an update of a series of trial-based and network meta-analyses assessing the efficacy of dietary, pharmacological and psychological therapies in treating IBS. Specific recommendations have been made according to the Grading of Recommendations Assessment, Development and Evaluation system, summarising both the strength of the recommendations and the overall quality of evidence. Finally, this guideline identifies novel treatments that are in development, as well as highlighting areas of unmet need for future research.

Systematic review, meta-analysis with subgroup analysis of hypnotherapy for irritable bowel syndrome, effect of intervention characteristics

BACKGROUND

Hypnotherapy has been shown to be effective at relieving global gastrointestinal symptoms (GGS) in irritable bowel syndrome (IBS). This study examines the impact of hypnotherapy delivery and participant characteristics on IBS outcomes.

METHODS

This systematic review searched CINAHL, Cochrane Library, Conference Citation Index, Embase, PubMed, PsycARTICLES, PsychINFO, Science Citation index-expanded, Social Science Citation Index. Titles and abstracts, then full-text articles were screened against inclusion criteria: trials with a concurrent comparator of hypnotherapy in adults with IBS diagnosed using Manning or ROME criteria, which provided symptom data. Included studies were extracted and assessed for bias using Cochrane Collaboration 2011 guidance. Random-effects meta-analysis was conducted with sub-group analysis to assess the impact of delivery characteristics on outcomes.

RESULTS

Twelve trials were included, 7 in the meta-analyses. Hypnotherapy reduced the risk of GGS, but this was not statistically significant, (standardised mean difference (SMD) 0.24, [-0.06, 0.54], I² 66 %). Higher frequency of sessions (≥1/week) reduced GGS (SMD 0.45 [0.23,0.67] I² 0 %), as did higher volumes of intervention (≥8 sessions with ≥6 h of contact) (SMD 0.51 [0.27,0.76] I² 0 %) and group interventions (SMD 0.45 [0.03, 0.88] I² 62 %). Only volume of intervention produced a significant effect between the subgroups.

CONCLUSION

This review suggests that high volume hypnotherapy is more beneficial than low and should be adopted for GDH. Both high frequency and group interventions are effective in reducing GGS in IBS. However, the sample size is small and more studies are needed to confirm this.

Adults living with irritable bowel syndrome (IBS): A qualitative systematic review

OBJECTIVE

To consolidate existing qualitative studies which examined the experiences and needs of adults living with IBS, and to gather a holistic insight for future directions and avenues to support these adults.

METHODS

A qualitative systematic review was conducted and six databases were searched for qualitative studies, beginning from each database's inception to July 2020. The qualitative data were meta-synthesised and thematic analysis was adopted. Any discrepancies that arose were discussed between the reviewers until a consensus was reached throughout the process of data screening, selection, critical appraisal and synthesis.

RESULTS

Seventeen studies with a total of 299 adults diagnosed with IBS were included. Four themes were identified: (1) physical, psychological, and social consequences; (2) impact of IBS on working adults; (3) dealing with IBS; and (4) sources of support and support needs.

CONCLUSION

Future research across geographically diverse locations are needed to gather a thorough perspective of the experiences and needs of adults living with IBS. The development and evaluation of technology-based, trained peer-led volunteers, and interventions that adopt mindfulness, active coping strategies, cognitive behavioural therapy and acceptance, and commitment therapy are needed. Ultimately, the collaboration between the relevant stakeholders is essential for standardised instruments and materials for accurate testing, diagnosis, assessment, treatment and management of IBS.

Online forum users' views and experiences of managing irritable bowel syndrome: a qualitative analysis of discussion content

Background

Irritable bowel syndrome (IBS) is common and often negatively affects quality of life. Patients frequently perceive medical interventions as inadequate and seek support from other sources, including online discussion forums.

Aim

To explore online discussion forum topics posted by people with IBS.

Design & setting

A qualitative study exploring three UK-based online discussion forums.

Method

A scoping review identified UK-based discussion forums with high activity and frequent use, which did not require a password/registration to view posts (two IBS-specific and one general health forum). Internal search functions were used to identify and export relevant discussion threads relating to managing IBS. Inductive thematic analysis of exported discussions was undertaken.

Results

Analysis identified two main overarching themes from 122 relevant discussion threads: 1) sharing information and practical advice about lifestyle changes; and 2) receiving emotional support. The most prevalent topics were lifestyle changes, including diet, using oral preparations (for example, supplements or probiotics), and physical activity. Dietary changes were usually considered positive, and most hopeful for potentially alleviating symptoms. Emotional support was also regularly offered with expressions of empathy, kindness, and gratitude, and a sense of users feeling less alone. Some discussions raised concern around potentially inappropriate symptomatic reassurance, and negative or conflicting advice.

Conclusion

Online forums seem, generally, to be a positive experience for those posting, but include potential risks of misinformation. Most posts focus on symptomatic relief through lifestyle change and/or emotional support. Clinicians could gain a better understanding of patients’ ideas, concerns, and expectations of IBS diagnosis and management by asking about patient-acquired online forum information.

An Intervention for Person-Centered Support in Irritable Bowel Syndrome: Development and Pilot Study

Irritable bowel syndrome is a common and often chronic functional bowel disorder that can cause severe disruption of daily functioning in those affected, with subsequent high healthcare utilization and work absenteeism. Nurses represent an underutilized group in the current management of irritable bowel syndrome. The aim of this study was to systematically develop a person-centered support intervention in irritable bowel syndrome and evaluate this in a pilot study. The development followed the revised framework for complex interventions from the Medical Research Council and involved literature reviews and multiprofessional expert groups. The intervention was then tested in a pilot study including 17 patients and evaluated through validated questionnaires measuring irritable bowel syndrome symptom severity, gastrointestinal-specific anxiety, and self-efficacy as well as through interviews. There was a significant improvement in irritable bowel syndrome symptom severity between baseline and follow-up, but not for self-efficacy or gastrointestinal-specific anxiety. The patients' perceptions of participating in the intervention were positive and induced a learning process; they were able to form a supportive relationship with the nurse and their ability to self-manage improved. The promising results from this small pilot study in terms of feasibility, potential efficacy, and the patients' positive feedback make this intervention a suitable candidate for a larger controlled trial.

Cognitive and Behavioral Differences Between Subtypes in Refractory Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal syndrome consisting of different bowel pattern subtypes: diarrhea predominant (IBS-D), constipation predominant (IBS-C), and alternating (IBS-A). This paper aimed to identify whether (a) psychological factors implicated in the cognitive behavioral model of IBS were differentially associated with bowel pattern subtypes, (b) whether there were differences in symptom severity and work and social adjustment across the IBS-subtypes. Analysis was conducted on baseline data of 557 individuals with refractory IBS recruited into the Assessing Cognitive Therapy in Irritable Bowel (ACTIB) randomized controlled trial. Correlations assessed the associations between psychological factors, stool patterns, symptom severity, and work and social adjustment. Hierarchical regressions identified whether cognitive and behavioral factors were significantly associated with frequency of loose/watery stools, hard/lumpy stools and symptom severity while controlling for affective (anxiety and depression) and demographic factors (age, gender, symptom duration). One-way ANOVAs were conducted to assess differences across Rome III classified subtypes (IBS-A, D and C) in cognitive, behavioral, affective, symptom severity, and adjustment measures. Psychological factors were significantly associated with symptom severity and work and social adjustment. Increased avoidance behavior and unhelpful gastrointestinal (GI) cognitions were significantly associated with higher frequency of loose/watery stools. Increased control behaviors were associated with higher frequency of hard/lumpy stools. Cognitive and behavioral differences were significant across the Rome III classified IBS subtypes. There were no differences in anxiety, depression, overall symptom severity, or work and social adjustment. The results are discussed in terms of their utility in tailoring cognitive behavioral treatments to IBS subtypes.

Experiences of the effects of physical activity in persons with irritable bowel syndrome (IBS): a qualitative content analysis

OBJECTIVE

Increased physical activity has been tested among patients with irritable bowel syndrome (IBS) in a randomized trial which demonstrated improvement in gastrointestinal (GI) symptoms. The patients' experiences of the effects of physical activity on IBS symptoms are unknown. This knowledge is necessary to enable suitable support from health care professionals. The aim of this study was therefore to explore patients' experiences of the effects of physical activity.

MATERIALS AND METHODS

Deep interviews were conducted with 15 patients (10 women and 5 men) aged 31-78 years. Their IBS had lasted for 10-57 years. The transcribed interviews were analyzed through a qualitative content analysis.

RESULTS

The analysis of the material revealed three themes; GI symptoms, extra-intestinal symptoms, and quality of life (QOL). In relation to GI symptoms, the patients discussed how physical activity affected these symptoms and how they used physical activity to normalize and control their GI symptoms. Extra-intestinal symptoms were also affected by physical activity, and the patients described how they experienced a general bodily wellbeing as well as improved mood and energy in relation to physical activity. In terms of QOL, the patients discussed their perspectives on physical activity as giving them achievements, being pleasurable, and being strengthening of the self.

CONCLUSIONS

Our results emphasize the importance of taking into account the patient's experiences of the effects of physical activity when coaching patients with IBS to be physically active. Using a person-centred approach incorporating, the patient's own experiences and resources is the key to successfully promoting physical activity in the clinic.

The experiences of physical activity in irritable bowel syndrome-A qualitative study

AIMS AND OBJECTIVES

To explore experiences of physical activity in patients with Irritable bowel syndrome.

BACKGROUND

Irritable bowel syndrome is a common functional bowel disorder. The knowledge of physical activity in Irritable bowel syndrome is limited and has not been qualitatively studied before.

METHODS

We adopted a qualitative approach and a hermeneutic analysis. Fifteen patients with Irritable bowel syndrome (10 women) with a median age of 52 (31-78) years were interviewed. The Consolidated criteria for reporting qualitative research was used.

RESULTS

Two themes emerged from the data: requirements of physical activity and capability for physical activity. The first of these consisted of five subthemes: add additional value, enable transportation, maintain health, cultivate interests and give a feeling of belonging. These qualities were the patients' requirements of physical activity and comprised the patients' motives and reasons for being physically active. The second consisted of four subthemes: life situation, earlier experiences, self-image, and symptom variation and described the possibility and resources to be physically active in everyday life. The patients made active choices to adjust their physical activity in terms of type, intensity and amount. The two main themes affect each other reciprocally.

CONCLUSIONS

The requirements of and capabilities for physical activity should be taken into account when giving advice to patients on physical activity. Physical activity for a person with Irritable bowel syndrome is about finding activities which meet the patient's individual requirements of and capability for physical activity.

RELEVANCE TO CLINICAL PRACTICE

This qualitative study on the experience pf physical activity in Irritable bowel syndrome provides knowledge to facilitate promoting physical activity among patients suffering from Irritable bowel syndrome. This knowledge can be used in other diagnosis.

Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

Background

Previous studies have identified issues with the doctor–patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms.

Aim

To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU).

Design and setting

This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fifty-two participants took part in semi-structured interviews post-treatment in UK primary and secondary care.

Method

Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data.

Results

Two key themes were identified: perceived paucity of GPs’ IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: reaching a ‘last-resort diagnosis’; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour.

Conclusion

In this refractory IBS group, specific doctor–patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.

Positive and negative affect mediate the bidirectional relationship between emotional processing and symptom severity and impact in irritable bowel syndrome

INTRODUCTION

Individuals with IBS report higher levels of psychological distress compared to healthy controls. Distress has been associated with emotional processing difficulties but studies have not explored how the relationship between distress and emotional processing affects IBS. There is little research on the role of positive affect (PA) in IBS.

AIMS

(a) If difficulties in self-reported emotional processing are associated with affect and IBS measures (i.e., symptom severity, interference in life roles) (b1) If affect mediates the relationship between emotional processing and IBS measures (b2) Alternative model: if affect mediates the relationship between IBS and emotional processing (c) If PA moderates the relationship between distress and IBS.

METHODS

Participants with a confirmed diagnosis of IBS (n=558) completed a questionnaire including measures of emotional processing (i.e., unhelpful beliefs about negative emotions, impoverished emotional experience), distress, PA, and IBS symptoms/interference. Mediation and moderation analyses were conducted with Maximum Likelihood Estimation.

RESULTS

Distress and PA mediated or partly mediated the relationship between unhelpful beliefs about negative emotions/impoverished emotional experience and both IBS measures. The alternative models were also valid, suggesting a two-way relationship between emotional processing and IBS through affect. PA did not moderate the relationship between distress and IBS.

CONCLUSION

Future interventions in IBS may benefit from not only targeting the management of physical symptoms and their daily impact but also aspects related to the experience of both negative and positive affect, and the acceptance and expression of negative emotions. Longitudinal studies are needed to confirm causal relationships within the explored models.

Irritable Bowel Syndrome: Patient-Provider Interaction and Patient Education

The Patient-Provider (P-P) relationship is the foundation of medical practice. The quality of this relationship is essential, particularly for the management of chronic illness such as Irritable Bowel Syndrome (IBS), since it correlates with disease improvement. A significant aspect of fostering the P-P relationship is providing effective patient-centered education about IBS. An effective education empowers the patients to achieve the main therapeutic goals: to reduce symptoms and improve quality of life. Method: A literature search of PubMed was conducted using the terms “Irritable Bowel syndrome”, “Patient Physician Relationship”, “Patient Provider Relationship”, and “Patient Physician interaction”. Preference was given to articles with a clearly defined methodology and those with control groups if applicable/appropriate. This article provides a review of the literature on Patient-Provider interaction and patient education as it relates to IBS and provides practical recommendations on how to optimize this important relationship.

A concept mapping study on perpetuating factors of functional somatic symptoms from clinicians' perspective

OBJECTIVE

The aim of this concept mapping study was to identify the structure and alleged importance of perpetuating factors of functional somatic symptoms (FSS) from the perspective of professionals. Further, we examined to which extent these factors have been addressed in scientific literature.

METHODS

Ninety-nine perpetuating factors were sorted with respect to content using a card-sorting task by 61 experienced clinicians (62.3% psychologists, 75.4% female, mean age: 45.7 [SD: 10.6] years, mean duration of experience in treating FSS patients: 10.5 [SD: 7.6] years). These factors had been derived from in-depth interviews with 12 clinicians, with extensive experience in treating FSS. Thirty-eight clinicians rated the importance of the 99 factors on a scale ranging from 1 ('not important at all') to 10 ('extremely important').

RESULTS

Hierarchical cluster analysis revealed three overarching domains of perpetuating factors: 'Hypochondria', 'Social and relational problems' and 'Symptom-related emotions and habits'. These domains comprised 16 clusters, which were rated on importance between 6.1, 'Adverse physical factors and counterproductive lifestyle', and 7.8, 'Frustration and despair regarding the symptoms'. All clusters have been addressed in scientific literature.

CONCLUSIONS

This study revealed an encompassing hierarchical structure of somatic, emotional, cognitive, behavioral, and social factors of importance in the perpetuation of FSS based on expert opinions. This structure will guide the development of personalized treatment of FSS.

Meanings of eating deficiencies for people admitted to palliative home care

Objective:

Food and eating are embedded in people's everyday social lives: at home with family members and as part of social interactions. For people with progressive life-limiting conditions, however, eating is often obstructed. The objective of the present study was to explore the meanings of living with eating deficiencies at the end of life among people admitted to specialist palliative home care.

Method:

This qualitative inductive study employed an interpretive descriptive approach. A dozen persons, with various diagnoses and eating deficiencies, admitted to two specialist palliative home care units, participated. Data were collected through individual repeated interviews. Data collection and analysis were guided by the interpretive description method.

Results:

The results reveal that eating deficiencies among people with progressive life-limiting conditions are existentially loaded markers of impending death. Finding ways to overcome declined food intake and hampered eating enabled our participants to feel able to influence their own well-being and remain hopeful. The results also showed that the eating deficiencies influenced participants' relationships and social interactions in ways that hampered their possibilities of sharing valuable moments together with friends and family members during the final period of life.

Significance of Results:

Efforts to minimize the distress that people experience in relation to the challenges they face with eating deficiencies are important for well-being at the end of life. Person-centered approaches to acknowledge and support individuals' own ways of experiencing and dealing with their eating deficiencies are recommended that include a multidimensional perspective on food and eating.