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Singh A, Ranjan P, Kumari A, Kaur T, Sarkar S, Sahu A, Prakash B, Kaloiya GS, Baitha U, Rawat N, Kuanar Baboo AG. Perspectives of patients, caregivers, and healthcare professionals in Indian context: A qualitative study on Medically Unexplained Physical Symptoms (MUPS). JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:119. [PMID: 37397120 PMCID: PMC10312410 DOI: 10.4103/jehp.jehp_1513_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/10/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND Approximately one-fourth of individuals who seek treatment in outpatient medical settings have Medically Unexplained Physical Symptoms (MUPS), a prevalent medical ailment. Patients with MUPS have a considerable functional impairment, and a lower quality of life, and may also have co-occurring psychiatric conditions. MATERIALS AND METHODS Eleven Focus Group Discussions (FGDs) (four virtual and seven face-to-face) were conducted with patients, caregivers, and healthcare professionals in 2021 in a tertiary care hospital in New Delhi. Thematic analysis was carried out using QSR Nvivo software. RESULTS A total of 36 participants were recruited in the study, including patients with MUPS (n = 12), caregivers (n = 10), and healthcare professionals (n = 14) dealing with the patients of MUPS. Three themes were identified: burden of MUPS, symptom profile of patients with MUPS, and psychological profile of patients with MUPS. These were further categorized into eight sub-themes: prevalence, symptoms, course of illness, improvement with treatment, duration of symptoms, attribution of symptoms, psychological impact, and coping strategies. CONCLUSION The study helped us to gain insight into the characteristics and experiences of patients, caregivers, and healthcare professionals dealing with MUPS in an Indian setup. Greater awareness of MUPS and training of care providers about the occurrence, management, and referral of MUPS can be beneficial.
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Affiliation(s)
- Amandeep Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aakansha Kumari
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anamika Sahu
- Student Wellness Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nandini Rawat
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ananta Gopal Kuanar Baboo
- Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
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Jøssang IH, Aamland A, Hjörleifsson S. Discovering strengths in patients with medically unexplained symptoms - a focus group study with general practitioners. Scand J Prim Health Care 2022; 40:405-413. [PMID: 36345858 PMCID: PMC9848323 DOI: 10.1080/02813432.2022.2139345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When patients suffer medically unexplained symptoms, consultations can be difficult and frustrating for both patient and GP. Acknowledging the patient as a co-subject can be particularly important when the symptoms remain unexplained. One way of seeing the patient as a co-subject is by recognizing any among their strong sides. OBJECTIVES To explore GPs' experiences with discovering strengths in their patients with medically unexplained symptoms and elicit GPs' reflections on how this might be useful. METHODS Four focus-groups with 17 GPs in Norway. Verbatim transcripts from the interviews were analyzed by systematic text condensation. RESULTS Recollecting patients' strengths was quiet challenging to the GPs. Gradually they nevertheless shared a range of examples, and many participants had experienced that knowing patients' strong sides could make consultations less demanding, and sometimes enable the GP to provide better help. Identifying strengths in patients with unexplained symptoms required a deliberate effort on the GPs' behalf, and this seemed to be a result of a strong focus on biomedical disease and loss of function. CONCLUSIONS Acknowledging patients' strong sides can bolster GPs' ability to help patients with medically unexplained symptoms. However, the epistemic disadvantage of generalist expertise makes this hard to achieve. It is difficult for GPs to integrate person-centered perspectives with biomedical knowledge due to the privileged position of the latter. This seems to indicate a need for system-level innovations to increase the status of person-centered clinical work. Key pointsMUS is challenging for both patients and GPs mainly because of the incongruence between symptoms and the dominating biomedical model.GPs' focus on pathology and loss of function can prevent them from discovering patients' strengths.Awareness of patients' strengths can make consultations less demanding for GPs and enable them to provide better help.A conscious effort is needed to discover patients' strengths.
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Affiliation(s)
- Ingjerd Helene Jøssang
- Department of global public health and primary care, University of Bergen, Norway
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
- CONTACT Ingjerd Helene Jøssang Research unit for general practice, NORCE Norwegian Research Centre, Årstadveien 17, Bergen5016, Norway
| | - Aase Aamland
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Stefan Hjörleifsson
- Department of global public health and primary care, University of Bergen, Norway
- Research unit for general practice, NORCE Norwegian Research Centre, Bergen, Norway
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Houwen J, de Bont OA, Lucassen PL, Rosmalen JGM, Stappers HW, Olde Hartman TC, van Dulmen S. Development of a blended communication training program for managing medically unexplained symptoms in primary care using the intervention mapping approach. PATIENT EDUCATION AND COUNSELING 2022; 105:1305-1316. [PMID: 34561144 DOI: 10.1016/j.pec.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND General practice (GP) training in how to communicate with patients with medically unexplained symptoms (MUS) is limited. OBJECTIVE Development, implementation and evaluation of an evidence-based communication training program for GP residents focused on patients with MUS in primary care. METHODS We used the intervention mapping (IM) framework to systematically develop the MUS training program. We conducted a needs assessment to formulate change objectives and identified teaching methods for a MUS communication training program. Next, we developed, implemented and evaluated the training program with 46 residents by assessing their self-efficacy and by exploring their experiences with the training. RESULTS The resulting program is a blended training with an online course and two training days. After attending the training program, GP residents reported significantly higher self-efficacy for communication with patients with MUS at four weeks follow up compared to baseline. Furthermore, GP residents experienced the training program as useful and valued the combination of the online course and training days. CONCLUSION AND PRACTICE IMPLICATIONS We developed an evidence-based communication training program for the management of patients with MUS in primary care. Future research should examine the effect of the training on GP residents' communication skills in MUS consultations in daily practice.
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Affiliation(s)
- Juul Houwen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands.
| | - Olga A de Bont
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Peter Lbj Lucassen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Judith G M Rosmalen
- University Medical Center Groningen, Interdisciplinary Center for Psychopathology and Emotion Regulation, Groningen, the Netherlands
| | - Hugo W Stappers
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; Nivel (Netherlands institute for health services research), Utrecht, The Netherlands
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Sallay V, Martos T, Lucza L, Weiland A, Stegers-Jager KM, Vermeir P, Mariman ANM, Csabai M. Medical educators' experiences on medically unexplained symptoms and intercultural communication-an expert focus group study. BMC MEDICAL EDUCATION 2022; 22:310. [PMID: 35461231 PMCID: PMC9034474 DOI: 10.1186/s12909-022-03275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are highly prevalent and remain challenging in healthcare and medical education, along with the increase in the importance of intercultural issues regarding MUS. However, less is known about the challenges of professionally addressing patients with MUS in the interprofessional and intercultural contexts. Thus, the present study aims to provide the first exploration of the experiences of medical specialists regarding treating MUS in intercultural contexts and inputs for training development on the intercultural aspects of MUS. METHODS Three focus groups (total n = 13) consisting of medical specialists from a Hungarian university who were teaching at the medical faculty in intercultural settings and also worked for the university health services were interviewed. The topics covered the participants' personal experiences on addressing MUS and the challenges of intercultural communication and the intercultural educational context. Thematic analysis was used to yield a qualitative account of the interviews as guided by the research questions. RESULTS Representing the different aspects of medical specialists, the study identified three main themes in the experiences of medical specialists, namely, 1) the need to adapt to the personal world of patients and search for common frames to understand MUS, 2) the need to discover methods for adapting to cultural differences and 3) the need to enhance the interprofessional coordination of knowledge and practices. CONCLUSIONS The results are in line with the distinct conclusions of previous studies. Moreover, an integrated educational program on the intercultural aspects of MUS may address the main themes separately and, subsequently, support their integration. Therefore, the study discusses the manner in which an integrated educational program on the intercultural aspects of MUS may address the needs recognized in these aspects.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
| | - Tamás Martos
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary.
| | - Lilla Lucza
- Doctoral School of Education, University of Szeged, Szeged, Hungary
| | - Anne Weiland
- Department for Internal Medicine & General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Peter Vermeir
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
| | - An Noelle Margareta Mariman
- Faculty of Medicine and Healthcare sciences, Ghent University, Ghent, Belgium
- Ghent University Hospital, Center for Integrative Medicine, Ghent, Belgium
| | - Márta Csabai
- Institute of Psychology, University of Szeged, Egyetem u. 2, 6722, Szeged, Hungary
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Kvamme MF, Wang CEA, Waage T, Risør MB. Careful expressions of social aspects: How local professionals in high school settings, municipal services, and general practice communicate care to youth presenting persistent bodily complaints. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1175-1184. [PMID: 30969453 DOI: 10.1111/hsc.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 02/21/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
Persistent health complaints pose communicative dilemmas in care encounters, adversely affecting patient experiences and pathways. Little is known about the impact and role of professionals in encounters with young people with incipient, debilitating, and persistent symptoms. This study aims to explore communicative dilemmas and the role of language in care provided by local professionals in high school settings, municipal services, and general practice to young people presenting persistent bodily complaints. The study is based on in-depth individual interviews conducted from April to July 2016 with 12 professionals identified and selected during anthropological multi-sited fieldwork in a Norwegian community. We identify two modalities of what we have chosen to call 'careful expression', used as strategies across professions to overcome communicative dilemmas. Professionals reflexively and pragmatically negotiated with the powers of language to influence illness experience and to enact empowered young subjects. These insights may prove relevant for future studies of care encounters while also indicating a critical attitude to institutional logics that affect care responses.
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Affiliation(s)
- Maria F Kvamme
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Catharina E A Wang
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Trond Waage
- Department of Social Sciences, Visual Cultural Studies, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mette B Risør
- Department of Community Medicine, General Practice Research Unit, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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van Westrienen PE, Pisters MF, Gerrits M, Veenhof C, de Wit NJ. Identifying Treatment Modalities for a Multidisciplinary and Blended Care Intervention for Patients With Moderate Medically Unexplained Physical Symptoms: Qualitative Study Among Professionals. JMIR Ment Health 2019; 6:e12203. [PMID: 30977737 PMCID: PMC6484260 DOI: 10.2196/12203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Medically 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. OBJECTIVE The 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. METHODS Two 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. RESULTS A 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. CONCLUSIONS From 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.
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Affiliation(s)
- Paula Elisabeth van Westrienen
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Martijn F Pisters
- Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands.,Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marloes Gerrits
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cindy Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Utrecht, Netherlands.,Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Niek J de Wit
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Aamland A, Øyeflaten I, Maeland S. Independent medical evaluation for sick-listed workers in Norway: A focus group study of the experience of IME doctors. Scand J Public Health 2017; 47:70-77. [PMID: 29199916 DOI: 10.1177/1403494817745001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Norwegian politicians have proposed the use of an independent medical evaluation (IME) as a possible solution for reducing long-term sick leave. The use of an IME implies that a new doctor interferes in the relationship between sick-listed workers and their general practitioner (GP). The aim of the current study was to explore experiences of IME doctors from an ongoing randomized controlled trial (the NIME trial evaluating the effect of IME in Norway). METHODS Two focus group interviews were conducted with eight of the nine IME doctors employed in the NIME trial. The discussions were audio-taped and transcribed. Systematic text condensation was used for analysis. RESULTS The participants reported that the IME provides important second opinions, which they felt empowered the sick-listed workers and provided new insights into their condition. Beneficial IME working conditions and enhanced insight into different sick leave measures were crucial to this perceived usefulness. Some of the participants expressed disappointment with GPs acting as passive conductors and struggled to provide feedback politely. Some adjustments were proposed as necessary for the IME to be implemented nationwide. CONCLUSIONS The participants seemed to have gained a different stakeholder identity by sometimes seeing GPs, their peers, as obstacles to return to work and welcomed the use of IME on a regular basis.
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Affiliation(s)
- Aase Aamland
- 1 Research Unit for General Practice, Uni Research Health, Norway
| | - Irene Øyeflaten
- 2 National Centre for Occupational Rehabilitation, Norway.,3 Uni Research Health, Uni Research, Norway
| | - Silje Maeland
- 3 Uni Research Health, Uni Research, Norway.,4 Department of Occupational Therapy, Physiotherapy and Radiography, Western Norway University of Applied Sciences, Norway
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What do guidelines and systematic reviews tell us about the management of medically unexplained symptoms in primary care? BJGP Open 2017; 1:bjgpopen17X101061. [PMID: 30564678 PMCID: PMC6169926 DOI: 10.3399/bjgpopen17x101061] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Helpful strategies for GPs seeing patients with MUPS. Br J Gen Pract 2017; 67:398. [DOI: 10.3399/bjgp17x692273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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