Patients’ perspectives on their interactions with general practitioners in the context of cognitive behavioural therapy for refractory irritable bowel syndrome: A qualitative study

Problem

Previous studies have identified issues with the doctor-patient relationship in IBS, which impact on symptom management and prognosis. Despite this, little research has explored the interactions between GPs and people with refractory IBS. These interactions can represent a particular challenge for doctors due to poor response to treatment in refractory IBS. NICE Guidelines suggest Cognitive Behavioural Therapy (CBT) as a treatment option for those with ongoing IBS symptoms, but current availability is limited. This study aimed to explore the perceptions that individuals with refractory IBS hold of the interactions with their GPs, after receiving either CBT for IBS or treatment as usual (TAU).

Approach

This qualitative study was embedded within a large trial assessing the effectiveness of CBT in refractory IBS. Fifty-two participants selected through purposive sampling took part in semi-structured interviews at post-treatment. Rigorous inductive thematic analysis was conducted to identify themes. NVivo 11 software was used to facilitate data management and increase the transparency of the findings.

Findings

Two themes captured patients’ perceptions of their GPs: Perceived paucity of GP’s knowledge of IBS and Lack of empathy from GPs. The perceived paucity of GP’s knowledge was described in the context of three main stages in participants’ experiences of IBS. The first stage was described as reaching a “last resort diagnosis”, characterised by lack of informational support. The second stage, finding the right treatment, was perceived as an exhausting trial and error process lacking patient involvement and significant symptom improvement. The last stage, long-term management, was mainly focused on the notion that long-term sufferers know more about IBS than doctors. The perceived lack of empathy from GPs was primarily associated with the functional nature of IBS and a poor understanding of the real impact IBS can have on patients’ quality of life. Only CBT participants reported a shared responsibility with their doctors concerning symptom management; TAU participants tended to report the need for reassurance from doctors.

Consequences

The current study highlights specific areas associated with each step of care that GPs could address to improve patients’ perceptions of IBS management in primary care. Framing realistic beliefs about the condition and its treatment could increase trust in doctors and potentially reduce GP consultations. Providing more information for patients on the process of diagnosing IBS; presenting IBS as a positive diagnosis (including an explanatory model for their symptoms); involving patients in potential treatment options (including a realistic appraisal of potential benefit) and acknowledging the impact of IBS on patients’ lives, appear to be key. Achieving this within time pressured GP consultations is challenging but could be enhanced through the development of simple GP support tools and information for patients, and through improved access to CBT for IBS (potentially online).