Reattribution for medically unexplained symptoms

Ravesteijn, H.J. van; Hartman, Tim olde

doi:10.1192/bjp.192.4.314a

Cited by 7 publications

(3 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reattribution training (RT) has provided mixed effects on patient outcome (Morriss et al 1998, 1999; Blankenstein, 2001; Morriss & Gask, 2002; Larisch et al 2004; Frostholm et al 2005; Rosendal et al 2005, 2007), including our recently conducted randomized controlled trial (RCT), which failed to demonstrate improved patient outcome, and in fact resulted in increased patient concern about their health, despite evidence that GPs had applied the reattribution model directly and successfully in consultations (Morriss et al 2007). One reason for these mixed results may be that reattribution is effective only when MUS patients give psychosocial cues spontaneously (Blankenstein, 2001; Rosendal et al 2007; van Ravesteijn et al 2008).…”

Section: Introductionmentioning

confidence: 99%

Randomized trial of reattribution on psychosocial talk between doctors and patients with medically unexplained symptoms

et al. 2009

View full text Add to dashboard Cite

After RT, some patients discussed psychosocial issues extensively but GPs did not probe underlying psychosocial issues. They gave mixed psychosocial and somatic messages about MUS, which may have increased patients' concerns about their health. GPs should actively seek the disclosure of underlying psychosocial problems and give clear, unambiguous messages to MUS patients when they are willing to discuss psychosocial issues.

show abstract

Section: Introductionmentioning

confidence: 99%

Randomized trial of reattribution on psychosocial talk between doctors and patients with medically unexplained symptoms

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Finally, we did not notice reattribution of the complaints by the GPs. From studies, it is known that reattribution is not helpful for MUS (33), so it is interesting that Dutch GPs apparently do not use this (anymore). Terpstra, T., Gol, J.M., Lucassen, P.L.B.J., Houwen, J., Dulmen, S. van, Berger, M.Y., Rosmalen, J.G.M., olde Hartman, T.C.…”

Section: Comparison With Literaturementioning

confidence: 99%

Explanations for medically unexplained symptoms: a qualitative study on GPs in daily practice consultations

Terpstra

Gol

Houwen³

et al. 2019

Family Practice

View full text Add to dashboard Cite

Background General practice is the centre of care for patients with medically unexplained symptoms (MUS). Providing explanations for MUS, i.e. making sense of symptoms, is considered to be an important part of care for MUS patients. However, little is known how general practitioners (GPs) do this in daily practice. Objective This study aimed to explore how GPs explain MUS to their patients during daily general practice consultations. Methods A thematic content analysis was performed of how GPs explained MUS to their patients based on 39 general practice consultations involving patients with MUS. Results GP provided explanations in nearly all consultations with MUS patients. Seven categories of explanation components emerged from the data: defining symptoms, stating causality, mentioning contributing factors, describing mechanisms, excluding explanations, discussing the severity of symptoms and normalizing symptoms. No pattern of how GPs constructed explanations with the various categories was observed. In general, explanations were communicated as a possibility and in a patient-specific way; however, they were not very detailed. Conclusion Although explanations for MUS are provided in most MUS consultations, there seems room for improving the explanations given in these consultations. Further studies on the effectiveness of explanations and on the interaction between patients and GP in constructing these explanations are required in order to make MUS explanations more suitable in daily primary care practice.

show abstract

“…This indicates that, in ordinary consultations aimed at exploring the problem space, it is essential for GPs to create an open conversation in which they actively listen to and collaborate with the patient. 43 Allowing patients the space to arrive at explanations themselves rather than imposing it on them could also help to create richer explanatory models, 20,44 as relations that were mentioned spontaneously by patients were presented in more detail than those in response to directive questions and prompting by the GP.…”

Section: Implications For Practicementioning

confidence: 99%

Patients’ descriptions of the relation between physical symptoms and negative emotions: a qualitative analysis of primary care consultations

et al. 2019

View full text Add to dashboard Cite

BackgroundPrimary care guidelines for the management of persistent, often ‘medically unexplained’, physical symptoms encourage GPs to discuss with patients how these symptoms relate to negative emotions. However, many GPs experience difficulties in reaching a shared understanding with patients.AimTo explore how patients with persistent symptoms describe their negative emotions in relation to their physical symptoms in primary care consultations, in order to help GPs recognise the patient’s starting points in such discussions.Design and settingA qualitative analysis of 47 audiorecorded extended primary care consultations with 15 patients with persistent physical symptoms.MethodThe types of relationships patients described between their physical symptoms and their negative emotions were categorised using content analysis. In a secondary analysis, the study explored whether patients made transitions between the types of relations they described through the course of the consultations.ResultsAll patients talked spontaneously about their negative emotions. Three main categories of relations between these emotions and physical symptoms were identified: separated (negation of a link between the two); connected (symptom and emotion are distinct entities that are connected); and inseparable (symptom and emotion are combined within a single entity). Some patients showed a transition between categories of relations during the intervention.ConclusionPatients describe different types of relations between physical symptoms and negative emotions in consultations. Physical symptoms can be attributed to emotions when patients introduce this link themselves, but this link tends to be denied when introduced by the GP. Awareness of the ways patients discuss these relations could help GPs to better understand the patient’s view and, in this way, collaboratively move towards constructive explanations and symptom management strategies.

show abstract

Reattribution for medically unexplained symptoms

Cited by 7 publications

References 14 publications

Randomized trial of reattribution on psychosocial talk between doctors and patients with medically unexplained symptoms

Randomized trial of reattribution on psychosocial talk between doctors and patients with medically unexplained symptoms

Explanations for medically unexplained symptoms: a qualitative study on GPs in daily practice consultations

Patients’ descriptions of the relation between physical symptoms and negative emotions: a qualitative analysis of primary care consultations

Contact Info

Product

Resources

About