Division of Psychiatry, School of Community Health Sciences, University of Nottingham, Queen's Medical School, Nottingham, UK.
Psychol Med. 2010 Feb;40(2):325-33. doi: 10.1017/S0033291709990353. Epub 2009 Jul 2.
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.
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.
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.
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.
在再归因中，全科医生（GP）直接请求心理社会信息，并在咨询中使用心理社会信息来解释医学无法解释的症状（MUS）。我们探讨了再归因培训（RT）是否会增加 GP 与 MUS 患者之间的心理社会信息交流，并减少躯体干预的交流。
一项针对 16 个实践中的 GP 的聚类随机对照试验（RCT），比较 RT 与常规治疗，纳入了 141 名 MUS 患者，对其在索引咨询中录制和转录的医患交流进行分析。在二次数据分析中，使用经验丰富的评估员应用利物浦临床互动分析方案（LCIAS）对索引咨询转录本中的每个言语轮次进行分析，评估时对治疗分配情况保持盲态。
在 RT 之后，患者更有可能透露和讨论心理社会问题，并提出对症状的心理社会解释；大约 25%的患者广泛讨论了心理社会信息。在 RT 组中，GP 没有寻求新的心理社会信息披露，但他们减少了对躯体干预的倡导。在 RT 之后，GP 平均提出了两个心理社会解释的话语和六个躯体干预的话语。
在 RT 之后，一些患者广泛讨论了心理社会问题，但 GP 并没有探究潜在的心理社会问题。他们对 MUS 给出了混合心理社会和躯体的信息，这可能增加了患者对健康的担忧。当 GP 愿意讨论心理社会问题时，他们应该积极寻求潜在心理社会问题的披露，并向 MUS 患者提供清晰、明确的信息。
