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

Published online by Cambridge University Press:  02 July 2009

R. Morriss ,
L. Gask ,
C. Dowrick ,
G. Dunn ,
S. Peters ,
A. Ring ,
J. Davies  and
P. Salmon
R. Morriss*
Affiliation:
Division of Psychiatry, School of Community Health Sciences, University of Nottingham, Queen's Medical School, Nottingham, UK
L. Gask
Affiliation:
National Primary Care Research and Development Centre, University of Manchester, UK
C. Dowrick
Affiliation:
Division of Primary Care, School of Behavioural, Community and Population Science, University of Liverpool, UK
G. Dunn
Affiliation:
Division of Epidemiology and Health Sciences, University of Manchester, UK
S. Peters
Affiliation:
Division of Psychology, School of Psychological Sciences, University of Manchester, UK
A. Ring
Affiliation:
Division of Primary Care, School of Behavioural, Community and Population Science, University of Liverpool, UK
J. Davies
Affiliation:
Computing Services Department, University of Liverpool, UK
P. Salmon
Affiliation:
Division of Clinical Psychology, School of Population, Community and Behavioural Sciences, University of Liverpool, UK
*
*Address for correspondence: R. Morriss, Professor of Psychiatry and Community Mental Health, Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham NG7 2UH, UK. (Email: [email protected])
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Abstract

Background

In reattribution, general practitioners (GPs) request psychosocial information directly and explain medically unexplained symptoms (MUS) using psychosocial information in the consultation. We explored whether reattribution training (RT) increased the communication of psychosocial information and decreased communication about somatic intervention between GPs and their MUS patients.

Method

A cluster randomized controlled trial (RCT) of RT versus usual treatment in GPs from 16 practices and 141 patients with MUS on audio-recorded and transcribed doctor–patient communication in an index consultation. In a secondary data analysis, the Liverpool Clinical Interaction Analysis Scheme (LCIAS) was applied by an experienced rater to each turn of speech in the transcript from the index consultation blind to treatment allocation.

Results

After RT, patients were more likely to disclose and discuss psychosocial problems, and propose psychosocial explanations for symptoms; around 25% of patients discussed psychosocial information extensively. In the RT group, GPs did not seek new psychosocial disclosure but they reduced advocacy for somatic intervention. After RT, GPs suggested, on average, two utterances of psychosocial explanation and six utterances of somatic intervention.

Conclusions

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.

Keywords

Communication barriersprimary health caresomatoform disorders
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 325 - 333
Copyright
Copyright © Cambridge University Press 2009

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