First rehabilitation consultation in patients of non-native origin: Factors that lead to tension in the patient–physician interaction

Sloots, Maurits; Scheppers, Emmanuel; Bartels, E.A.C.; Dekker, J.; Geertzen, Joannes; Dekker, J.

doi:10.1080/09638280902847085

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…Differences in the utilization and outcomes of rehabilitation between German and non-German nationals cannot be explained by differences in health status or demographic and socio-economic factors [ 11 , 13 – 15 ]. Similar results were reported from other countries [ 16 – 19 ]. For example, Sloots et al observed higher rates of drop-out from rehabilitation among Turkish and Moroccan migrants as compared to the Dutch majority population in the Netherlands [ 16 , 17 ].…”

Section: Introductionsupporting

confidence: 92%

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Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Brzoska

Sauzet

Yılmaz-Aslan

et al. 2016

BMC Health Serv Res

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BackgroundIn many European countries, foreign nationals experience, on average, less favorable treatment outcomes in rehabilitative care than the respective majority population. In Germany, this for example is reflected in a lower occupational performance and a higher risk of disability retirement after rehabilitation as analyses of routine data show. However, little is known about the perspective of health care users. The aim of the present study was to compare self-rated treatment outcomes between German and non-German nationals undergoing in-patient medical rehabilitation in Germany.MethodsWe analyzed data from a cross-sectional representative rehabilitation patient survey of 239,811 patients from 642 clinics in Germany who completed about 3 weeks of in-patient rehabilitative treatment. The self-rating of the treatment outcome was based on a dichotomized Likert scale consisting of three items. A multilevel logistic regression analysis adjusted for various demographic, socio-economic, health and other covariates was conducted to examine differences in the self-rated treatment outcome between German and non-German nationals.ResultsOf the 239,811 respondents 0.9 % were nationals from Turkey, 0.8 % had a nationality from a former Yugoslavian country, 0.9 % held a nationality from the South European countries Portugal, Spain, Italy or Greece and 1.9 % were nationals from other countries. Non-German nationals reported a less favorable self-rated outcome than Germans. Adjusted odds ratios [OR] for reporting a less favorable treatment outcome were 1.24 (95 %-confidence interval [95 %-CI]: 1.12–1.37) for nationals from the South European countries Portugal/Spain/Italy/Greece, 1.62 (95 %-CI: 1.45–1.80) for Turkish nationals and 1.68 (95 %-CI: 1.52–1.85) for nationals from Former Yugoslavia.ConclusionsKnowledge on health outcomes from the patients’ point of view is important for the provision of patient-centered health care. Our study showed that non-German nationals report less favorable outcomes of rehabilitative care than Germans. This may be due to cultural and religious needs not sufficiently addressed by health care providers. In order to improve rehabilitative care for non-German nationals, rehabilitative services must become sensitive to the needs of this population group. Diversity management can contribute to this process.

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Section: Introductionsupporting

confidence: 92%

“…Similar results were reported from other countries [ 16 – 19 ]. For example, Sloots et al observed higher rates of drop-out from rehabilitation among Turkish and Moroccan migrants as compared to the Dutch majority population in the Netherlands [ 16 , 17 ].…”

Section: Introductionsupporting

confidence: 92%

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Brzoska

Sauzet

Yılmaz-Aslan

et al. 2016

BMC Health Serv Res

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“…This is disturbing, as educational level (as an indicator of socioeconomic status) is inversely related to the duration and recurrence of back pain (Dionne et al, 2001); a stronger consideration of the demands of patients with low socioeconomic status might improve prognosis. Similarly, a stronger consideration of the cultural background of patients could help to change inappropriate beliefs about the origin and treatment of low back pain, generate more realistic expectations regarding rehabilitation and thereby enhance outcomes (Sloots et al, 2009). We also did not find any sex-specific recommendations referring to interventions tailored for women.…”

Section: Discussionmentioning

confidence: 53%

Psychological interventions in the rehabilitation of patients with chronic low back pain

Reese¹,

Mittag²

2013

International Journal of Rehabilitation Research

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The purpose of the article is to summarize evidence and recommendations for psychological interventions in the rehabilitation of patients with chronic low back pain. We carried out a systematic literature search in several databases and on the websites of professional associations to identify relevant reviews and guidelines. In addition to the electronic search, a handsearch was carried out. Eligible publications were selected. We extracted and summarized both evidence for psychological interventions and recommendations on psychological diagnostics and interventions. Six systematic reviews and 14 guidelines were included. We collected recommendations and partially restricted evidence on the following psychological interventions: behavioural therapy, fear-avoidance training, stress management, relaxation therapy, patient education and back school. Most available evidence for psychological interventions in the rehabilitation of patients with chronic low back pain is of moderate to low quality. In addition, some of the older evidence is inapplicable to modern interventions using a biopsychosocial approach. Thus, high quality and current evidence is needed. The summary of guidelines shows that multimodal, multidisciplinary programmes including psychological interventions have become standard in the rehabilitation of patients with chronic low back pain. In most guidelines, however, there are no recommendations on which (psychological) intervention should be considered for which specific problem (problem-treatment pairs). Suggestions for future research and future guidelines are made.

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“…Two reviewers identified 492 potential concepts in 77 primary studies ( Figure 3). They excluded 115 potential concepts for the following reasons: inadequate conceptualisation (31 concepts in 17 studies 11,150,155,160,162,169,173,178,181,188,192,196,197,206,208,219 ); did not explore HCP experience (18 concepts in seven studies 168,174,198,202,203,215,223 ); and explored a topic with limited transferability beyond a specific context (five concepts in five studies 166,167,197,208,223 ). We agreed that for some topics there were insufficient concepts to allow us to develop robust conceptual categories: return to work (seven concepts in two studies 167,182 ), ethnicity (11 concepts in five studies 171,204,205,215,216 ), gender (seven concepts in one study 206 ) and older people (21 concepts in nine studies 159,160,162,165,176,187,194,199,…”

Section: Coding and Conceptual Categoriesmentioning

confidence: 99%

“…Relevance and aim of included studies (continued ) First author and year Relevance Study aim Slade 2012 214 Direct To investigate how physiotherapists prescribe exercise for people with non-specific chronic low-back pain in the absence of definitive or differential diagnoses a Sloots 2009215 Direct To explore which factors lead to tension in the patient-physician interaction in the first consultation by rehabilitation physicians of patients with chronic non-specific low-back pain who are of Turkish and Moroccan origin…”

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confidence: 99%

A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care

Toye

Seers

Barker

2018

Health Serv Deliv Res

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Background People with chronic pain do not always feel that they are being listened to or valued by health-care professionals (HCPs). We aimed to understand and improve this experience by finding out what HCPs feel about providing health care to people with chronic non-malignant pain. We did this by bringing together the published qualitative research. Objectives (1) To undertake a qualitative evidence synthesis (QES) to increase our understanding of what it is like for HCPs to provide health care to people with chronic non-malignant pain; (2) to make our findings easily available and accessible through a short film; and (3) to contribute to the development of methods for QESs. Design We used the methods of meta-ethnography, which involve identifying concepts and progressively abstracting these concepts into a line of argument. Data sources We searched five electronic bibliographic databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Allied and Complementary Medicine Database) from inception to November 2016. We included studies that explored HCPs’ experiences of providing health care to people with chronic non-malignant pain. We utilised the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework to rate our confidence in the findings. Results We screened 954 abstracts and 184 full texts and included 77 studies reporting the experiences of > 1551 HCPs. We identified six themes: (1) a sceptical cultural lens and the siren song of diagnosis; (2) navigating juxtaposed models of medicine; (3) navigating the patient–clinician borderland; (4) the challenge of dual advocacy; (5) personal costs; and (6) the craft of pain management. We produced a short film, ‘Struggling to support people to live a valued life with chronic pain’, which presents these themes (see Report Supplementary Material 1; URL: www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419807/#/documentation; accessed 24 July 2017). We rated our confidence in the review findings using the GRADE-CERQual domains. We developed a conceptual model to explain the complexity of providing health care to people with chronic non-malignant pain. The innovation of this model is to propose a series of tensions that are integral to the experience: a dualistic biomedical model compared with an embodied psychosocial model; professional distance compared with proximity; professional expertise compared with patient empowerment; the need to make concessions to maintain therapeutic relationships compared with the need for evidence-based utility; and patient advocacy compared with health-care system advocacy. Limitations There are no agreed methods for determining confidence in QESs. Conclusions We highlight areas that help us to understand why the experience of health care can be difficult for patients and HCPs. Importantly, HCPs can find it challenging if they are unable to find a diagnosis and at times this can make them feel sceptical. The findings suggest that HCPs find it difficult to balance their dual role of maintaining a good relationship with the patient and representing the health-care system. The ability to support patients to live a valued life with pain is described as a craft learnt through experience. Finally, like their patients, HCPs can experience a sense of loss because they cannot solve the problem of pain. Future work Future work to explore the usefulness of the conceptual model and film in clinical education would add value to this study. There is limited primary research that explores HCPs’ experiences with chronic non-malignant pain in diverse ethnic groups, in gender-specific contexts and in older people living in the community. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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First rehabilitation consultation in patients of non-native origin: Factors that lead to tension in the patient–physician interaction

Abstract: Sources of tension were identified during the interaction between Dutch physicians and patients of Turkish and Moroccan origin. These factors potentially are associated with future drop-out. Future research should clarify whether these factors indeed are associated with drop-out.

Cited by 14 publications

References 15 publications

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Self-rated treatment outcomes in medical rehabilitation among German and non-German nationals residing in Germany: an exploratory cross-sectional study

Psychological interventions in the rehabilitation of patients with chronic low back pain

A meta-ethnography of health-care professionals’ experience of treating adults with chronic non-malignant pain to improve the experience and quality of health care

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