How do neurologists discuss functional symptoms with their patients: A conversation analytic study

This study examines the subjective experience of living with epilepsy or psychogenic nonepileptic seizures (PNES) by thematically comparing individuals' written accounts of their condition. Five key differences emerged. Theme 1: 'Seizure onset' revealed differences in how individuals think about and ruminate over the possible causes of their condition. Theme 2: 'Emotive tone' demonstrated that writings of those with epilepsy reflected stable emotions (no intense emotional reactions) whereas those of writers with PNES reflected anxiety and low mood. Theme 3:

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“…a psychosocial interpretation of their symptoms) (Monzoni, Duncan, Gruenewald, & Reuber, 2011a, 2011b). …”

Section: Discussionmentioning

confidence: 99%

Written Accounts of Living With Epilepsy or Psychogenic Nonepileptic Seizures: A Thematic Comparison

et al. 2018

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“…However, in the former setting they typically work to secure acceptance of the original recommendation; in the latter, they usually reformulate the recommendation. In UK neurology consultations, Monzoni et al 49,50 have shown that the neurologist may sometimes abandon the treatment recommendation altogether: when patients fail to accept a psychosocial explanation for their symptoms, it becomes difficult for the neurologist to propose psychological treatment. Further, Costello and Roberts 48 demonstrated that -whether or not patients display resistance -doctors in both oncology and internal medicine clinics routinely orient to the patient's right to accept or reject their recommendations through the interactional work they do to justify them.…”

Section: This Focus Began With Stivers'mentioning

confidence: 99%

“…These are not, then, like other choice conversations in so far as the neurologist may be consciously trying both to 'back the patient into a corner' (so that a diagnosis can be achieved), and to involve the patient in the decision-making process in an effort to shift him/her out of the helplessness and avoidance that this patient group often displays. 49,50 Moreover, if the patient is accompanied (as in Extracts 17a-d), much of what is said may be partially directed at the relative/partner, whose agenda may be more akin to the neurologist's than the patient's.…”

Section: Implications For Cliniciansmentioning

confidence: 99%

Delivering patient choice in clinical practice: a conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making

Reuber

Toerien

Shaw

et al. 2015

Health Services and Delivery Research

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BackgroundThe NHS is committed to offering patients more choice. Yet even within the NHS, the meaning of patient choice ranges from legal ‘rights to choose’ to the ambition of establishing clinical practice as a ‘partnership’ between doctor and patient. In the absence of detailed guidance, we focused on preciselyhowto engage patients in decision-making.ObjectivesTo contribute to the evidence-base about whether or not, and how, patient choice is implemented to identify the most effective communication practices for facilitating patient choice.DesignWe used conversation analysis to examine practices whereby neurologists offer choice. The main data set consists of audio- and video-recorded consultations. Patients completed pre- and post-consultation questionnaires and neurologists completed the latter.Setting and participantsThe study was conducted in neurology outpatient clinics in Glasgow and Sheffield. Fourteen neurologists, 223 patients and 120 accompanying others took part.ResultsPatients and clinicians agreed that choice had featured in 53.6% of consultations and that choice was absent in 14.3%. After 32.1% of consultations,eitherpatientorneurologist thought choice was offered. The presence or absence of choice was not satisfactorily explained by quantitatively explored clinical or demographic variables. For our qualitative analysis, the corpus was divided into four subsets: (1) patient and clinician agree that choice was present; (2) patient and clinician agree that choice was absent; (3) patient ‘yes’, clinician ‘no’; and (4) patient ‘no’, clinician ‘yes’. Comparison of all subsets showed that ‘option-listing’ was the only practice for offering choice that was presentonly(with one exception, which, as we show, proves the rule) in those consultations for which participantsagreed there was a choice. We show how option-listing can be used to engage patients in decision-making, but also how very small changes in the machinery of option-listing [for instance the replacement or displacement of the final component of this practice, the patient view elicitor (PVE)] can significantly alter the slot for patient participation. In fact, a slightly modified form of option-listing can be used to curtail choice. Finally, we describe two forms of PVE that can be used to hand a single-option decision to the patient, but which, we show, can raise difficulties for patient choice.ConclusionsChoice features in the majority of recorded consultations. If doctors want to ensure a patient knows she or he has a choice, option-listing is likely to be best understood by patients as an invitation to choose. However, an important lesson from this study is that simply asking doctors to adopt a practice (like option-listing) will not automatically lead to a patient-centred approach. Our study shows that preciselyhowa practice is implemented is crucial.Future researchFuture research should investigate (1) links between the practices identified here and relevant outcome measures (like adherence); (2) whether being given a choice is better or worse for patients than receiving a doctor’s recommendation, taking account of clinical and demographic factors; and (3) how our approach could be fruitfully applied in other settings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Several previous studies have shown that patients with both NES [3][5] and FW [4] tend to reject psychological factors as potentially causal factors [14] [15]. Reasons for this may include the stigma of associated psychological factors when there is no validating disease label and a possible tendency of some patients to deny or not to be able to perceive psychological factors of potential relevance [16,17].…”

Section: Discussionmentioning

confidence: 99%

Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness

Ludwig

Whitehead

Sharpe

et al. 2015

Journal of Psychosomatic Research

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Word Count excluding abstract and tables: 1590Abstract 259 Abstract ObjectivesIllness perceptions are considered to play an important role in the onset and maintenance of symptoms in Functional Neurological Symptom Disorder (Conversion Disorder). There has, however, been little work examining differences between subtypes of this disorder. We therefore aimed to compare illness perceptions of patients with non-epileptic seizures (NES) and those with functional weakness (FW) with matching neurological disease controls to examine their specificity. MethodsThe Illness Perception Questionnaire Revised (IPQ-R) was completed by patients with functional limb weakness, non-epileptic seizures and patients with neurological disease causing limb weakness and epilepsy in two separate case control studies. ResultsPatients with FW (n=107), NES (=40), Epilepsy (n=34) and neurological disease causing limb weakness (NDLW) (n=46) were included in the analysis. Both FW and NES patients reported a low level of personal control, understanding of their symptoms and a tendency to reject a psychological causation of their symptoms. However NES patients rejected psychological causes less strongly than FW patients (p<0.01), including the single 'stress' item of the IPQ-R (p<0.01). Patients with NES were also more likely to consider their treatment to be more effective (p<0.01). None of these differences appeared in a similar comparison between patients with epilepsy and patients with NDLW. ConclusionAlthough patients with NES tend, as a group, to reject psychological factors as relevant to their symptoms, they did so less strongly than patients with functional limb weakness in these cohorts. This has implications for both the way in which these symptoms are grouped together but also the way in which explanations and treatment is approached.

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How do neurologists discuss functional symptoms with their patients: A conversation analytic study

Cited by 64 publications

References 35 publications

Written Accounts of Living With Epilepsy or Psychogenic Nonepileptic Seizures: A Thematic Comparison

Written Accounts of Living With Epilepsy or Psychogenic Nonepileptic Seizures: A Thematic Comparison

Delivering patient choice in clinical practice: a conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making

Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness

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