Co-constructing explanations for persistent physical symptoms: knowledge work in action

THE PROBLEM:

Patients with persistent physical symptoms often make repeated GP visits, the outcome of which are unsatisfactory for both the patient and the GP. Evidence suggests that a mismatch in understanding between the patient’s experience and the doctor’s models of illness is an important factor in this.

YOUR APPROACH:

Multiple Symptoms Study 3 is a multi-centre trial of an Extended-Role GP intervention for patients with PPS. Using knowledge from previous research into how GPs communicate with patients with PPS in general practice, we designed an intervention which contains the following elements: Recognition, Explanation, Action and Learning (REAL). Embedded in this is qualitative research to understand how the intervention works in practice. Consultation transcripts and participant interviews are inductively analysed, drawing on phenomenology and grounded theory.

THE LEARNING:

Analysis so far has revealed the importance of a successful co-construction between the patient and the GP, within the explanation and action elements of the intervention. The recognition element of the intervention is an important part of the co-construction, and we have identified other enablers and barriers to creating a co-construction within this context. For example, anchoring explanations in the patients existing knowledge enables a successful co-construction, whereas challenging patients thought processes too early in the intervention can be a barrier to co-construction.

WHY IT MATTERS:

A successful co-construction appears to be an important precursor of patient’s willingness to engage in strategies that may help to manage their symptoms, and therefore has implications for the delivery of care to these patients. GPs may be able to use this knowledge as a tool in their own practice, to enhance their communication with patients with PPS.

Presenting author:

Dr Kate Fryer, Academic Unit of Primary Care, University of Sheffield.

Email: k.fryer@sheffield.ac.uk

Co-authors:

Professor Chris Burton, Academic Unit of Primary Care, University of Sheffield.

Email: chris.burton@sheffield.ac.uk

Professor Monica Greco, Department of Sociology, Goldsmiths University London

Email: m.greco@gold.ac.uk

Dr Tom Sanders

Social Work, Education and Community Wellbeing, Northumbria University