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P12 Communication interventions for medically unexplained symptom conditions: a systematic review and meta-analysis
  1. Ailish Byrne1,
  2. Arabella Scantlebury1,
  3. Katherine Jones2,
  4. Laura Doherty1,
  5. David Torgerson1,
  6. Christina van der Feltz Cornelis3
  1. 1York Trials Unit, University of York, York, UK
  2. 2Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  3. 3Mental Health and Addictions Research Group, University of York, York, UK

Abstract

Background Medically unexplained symptoms (MUS) are difficult to diagnose due to their unknown aetiology, symptom overlap, and lack of effective treatments. MUS patients’ and general practitioners (GP) frequently face challenges during consultations: GPs report difficulty identifying and classifying MUS and patients report feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS. This systematic review and meta-analysis aimed to evaluate the effectiveness of primary care based communication interventions at improving MUS patients’ and/or clinician outcomes and identify future research priorities for general practice.

Methods Four electronic databases (Embase, MEDLINE, CENTRAL and CINHAL) were searched from inception to November 2021. Studies investigating a communication intervention delivered to GPs for the consultation of MUS patients and evaluated through a randomised controlled trial were eligible for inclusion. Two researchers independently undertook screening, data extraction and quality appraisal using the Cochrane Risk of Bias Tool. Narrative syntheses were conducted, along with meta-analyses where possible to pool data.

Results After deduplication, 113 records were screened (89 at title/abstract, 24 at full-text). A review of reference and citation lists highlighted 3 additional papers. 9 papers from 10 Randomised Controlled Trials met the inclusion criteria. All included studies displayed moderate or high risk of bias and were methodologically weak. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (e.g.: reattribution) could improve pain, mental and physical functioning. Reattribution training may improve clinician confidence treating MUS. Methodological limitations mean that these findings should be interpreted with caution. Meta-analysis found no improvement for patients’ anxiety or depression.

Conclusion A range of interventions for improving communication with MUS patients in primary care were evaluated. The heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. High quality research into the efficacy of communication interventions within primary care is needed. Before considering further randomised controlled trials researchers should focus on expanding the evidence base and developing a new or modified communication intervention for MUS patients and clinicians. To facilitate this evidence syntheses, incorporating evidence from non-randomised controlled trials, non-MUS conditions, and/or exploring which components of existing communication interventions work and could be incorporated into a modified intervention would be of benefit. Additionally, a core outcome set for MUS research is needed.

  • Primary care
  • communication interventions: medically unexplained symptom conditions

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