Clinical Assessment as Therapy in managing Medically Unexplained Symptoms
Projectomschrijving
Patiënten met Somatisch Onverklaarde Lichamelijke Klachten (SOLK) zijn vaak niet tevreden met de zorg die ze van hun huisarts krijgen. Het ontbreekt aan een effectieve behandeling die acceptabel is voor patiënten en makkelijk in te passen is in het spreekuur van de huisarts.
Doel
Het doel van dit project was de ontwikkeling van een effectieve behandeling bij SOLK, waarbij de arts-patiënt-communicatie en de arts-patiënt-relatie centraal staat. Deze elementen hebben namelijk grote invloed op gezondheidsuitkomsten. We hebben een evidence-based communicatietraining ontwikkeld, geïmplementeerd en geëvalueerd voor huisartsen in opleiding.
Werkwijze
De ontwikkeling, implementatie en evaluatie van de communicatietraining bestond uit 4 stappen:
- Verkennen van belangrijke en relevante communicatie-elementen in SOLK consulten volgens patiënten met SOLK en huisartsen.
- Verkennen van de meest belangrijke communicatie-elementen in SOLK consulten volgens SOLK experts.
- Ontwikkelen van een evidence-based communicatietraining voor huisartsen met behulp van de intervention mapping methode. De training bestond uit het volgen van een e-learning en 2 onderwijsdagen. Tijdens de onderwijsdagen oefenden AIOS met elkaar en met acteurs.
- Implementatie en evaluatie van de communicatietraining. We hebben de training geïmplementeerd in de huisartsopleiding van het Radboudumc en het Universitair Medisch Centrum Groningen.
Interview
Onderzoeker en huisarts Juul Houwen vertelt waar het misgaat in de communicatie tussen huisartsen en patiënten. Benieuwd wat de 5 belangrijkste tips zijn? En waarom het hem weinig moeite kostte om deelnemers voor zijn onderzoek te vinden?
Aanbevelingen
- Focus als huisarts op arts-patiënt communicatie. De meest belangrijke communicatie-elementen zijn daarin: het volledig exploreren van de klacht, communiceren met empathie, creëren van een gedeelde probleemdefinitie, geven van uitleg en het nemen van regie.
- Evalueer als huisarts de werkhypothese SOLK continu opnieuw.
- Reflecteer als huisarts op de eigen houding ten opzichte van patiënten met SOLK.
- De ontwikkelde SOLK training moet worden geïmplementeerd in de Nederlandse huisartsenopleiding.
Proefschrift Juul Houwen
Artikelen
Producten
Auteur: Houwen, Juul, Lucassen, Peter L B J, Stappers, Hugo W, Assendelft, Pim J J, van Dulmen, Sandra, olde Hartman, Tim C
Magazine: Family Practice
Auteur: Terpstra, Tom, Gol, Janna M, Lucassen, Peter L B J, Houwen, Juul, van Dulmen, Sandra, Berger, Marjolein Y, Rosmalen, Judith G M, olde Hartman, Tim C
Magazine: Family Practice
Auteur: Houwen, Juul, Lucassen, Peter L. B. J., Verwiel, Anna, Stappers, Hugo W., Assendelft, Willem J. J., olde Hartman, Tim C., van Dulmen, Sandra
Magazine: BMC Family Practice
Auteur: Houwen, Juul, Lucassen, Peter LBJ, Stappers, Hugo W, Assendelft, Willem JJ, van Dulmen, Sandra, Hartman, Tim C olde
Magazine: British Journal of General Practice
Auteur: Gol, Janna, Terpstra, Tom, Lucassen, Peter, Houwen, Juul, van Dulmen, Sandra, Olde Hartman, Tim C, Rosmalen, Judith
Magazine: British Journal of General Practice
Auteur: Stortenbeker, Inge, Houwen, Juul, van Dulmen, Sandra, olde Hartman, Tim, Das, Enny
Magazine: Patient Education and Counseling
Auteur: Stortenbeker, Inge A., Houwen, Juul, Lucassen, Peter L.B.J., Stappers, Hugo W., Assendelft, Willem J.J., van Dulmen, Sandra, olde Hartman, Tim C., Das, Enny
Magazine: Patient Education and Counseling
Auteur: Houwen, Juul, Moorthaemer, Bas J. E., Lucassen, Peter L. B. J., Akkermans, Reinier P., Assendelft, Willem J. J., olde Hartman, Tim C., Dulmen, Sandra
Magazine: Health expectations
Auteur: Houwen, Juul, Lucassen, Peter LBJ, Dongelmans, Stijn, Stappers, Hugo W, Assendelft, Willem JJ, van Dulmen, Sandra, olde Hartman, Tim C
Magazine: British Journal of General Practice
Verslagen
Eindverslag
Samenvatting van de aanvraag
Background: Medically unexplained symptoms (MUS) are common in all kinds of medical specialties and represent a wide variety of unspecified symptoms without detectable underlying disease, thereby inducing a large volume of healthcare consumption. Patients with MUS suffer from their symptoms, are functionally impaired, and are at risk for potentially harmful additional testing and treatment procedures. Furthermore, MUS patients are dissatisfied with the care they receive as they do not receive the care they need, they do not feel recognized and they lack empathy and support from their general practitioner (GP). Although the burden of MUS for patients, healthcare and society is high, effective and acceptable evidence based treatment strategies in primary care are still lacking. Lack of involvement of patients with MUS in designing treatment strategies might have contributed to the absence of acceptable effective interventions. In the current medico-technical era, clinical researchers mainly focus on specific therapeutic interventions for distinct diseases, neglecting the benefits of the consultation process itself. We hypothesize that the clinical assessment (history taking, physical examination, request of additional testing, explanation of what is wrong, and advice) of symptoms and non-specific therapeutic elements (such as expectations, positive communication, empathy and support) during the consultation process are a promising guide towards an effective, acceptable and feasible treatment strategy for patients with MUS in primary care. Aim: My aim is to develop a Clinical Assessment as Therapy in managing Medically Unexplained Symptoms (CATMUS) intervention, a theory- and evidence-based effective communication intervention for General Practitioners (GPs), which is also acceptable for patients with MUS and feasible in daily general practice. This new treatment model, to be applied within the primary care setting, will focus on the therapeutic benefits of the consultation process itself. Method: In order to develop this new and innovative communication intervention for GPs, we will use the Intervention Mapping (IM) approach, a systematic approach to intervention development containing the following steps. STEP 1 (needs assessment) is an innovative video consultation study in which patients and GPs observe and comment on their own video-recorded MUS consultation. One week after recording the videotaped consultation in daily practice, patients and GPs are invited to comment on the consultation(s) independently. These comments will be analysed qualitatively in order to get insight into issues leading to a successful MUS consultation. STEP 2 (change objectives) is a focus group study with focus groups with experts in the field of MUS and communication, GPs and patients. In these focus groups we will define the most important communication determinants during encounters with patients with MUS and explore how these communication determinants can be changed or adapted in order to improve communication skills in the MUS consultation. STEP 3 (test version) is the development of the test version of the new communication intervention using the concrete suggestions and tools provided by the focus group discussions and the body of knowledge of all existing interventions currently known in primary care. The test intervention will be tested for feasibility and acceptability by 5 trained GPs each treating 4 standardized (simulated) MUS patients (SPs) with this intervention in the communication laboratory. STEP 4 (CATMUS pilot RCT): is a pilot RCT (including 50 MUS patients and 10 GPs) in order to evaluate recruitment and trial retention, acceptability (in GPs and MUS patients) and potential treatment effects of the CATMUS intervention for a full trial. Patients with MUS will be selected by the GP. The 5 GPs in the intervention arm will be trained to treat 5 patients each with the CATMUS intervention; the other 5 GPs will treat the patients as normal. The included patients will be followed for half a year and will be asked to complete questionnaires at baseline, 3 and 6 months. Patient identification and recruitment, trial retention and acceptability of the intervention will be established. Innovation: This is the first time that an intervention for MUS patients will be developed (1) with intensive participation of MUS patients, (2) with the clinical assessment as the focus of improvement, and (3) with conscious use of non-specific elements as therapeutic agents. Especially the explicit use of non-specific therapeutic elements is promising in medicine and will be an answer to a better personalized healthcare for MUS patients and the raise of health care expenditures nowadays.