Holt Nicola, Pincus Tamar, Vogel Steven
Department of Psychology, Royal Holloway, University of London, Egham, Surrey.
Research, British School of Osteopathy, London.
Br J Gen Pract. 2015 Oct;65(639):e692-701. doi: 10.3399/bjgp15X686953.
Reassurance is commonly recommended in guidelines for the management of low back pain in primary care, although it is poorly defined, and what it means to patients remains unknown.
To explore how patients with low back pain perceive practitioners' reassuring behaviours during consultations.
Qualitative study undertaken with patients from nine GP surgeries in Northamptonshire, England.
Twenty-three patients who had recently consulted for non-specific low back pain were recruited from general practice. Semi-structured interviews explored what they had found reassuring during their consultations and the effect of such reassurance since their consultations. Interview transcripts were analysed using the thematic framework method.
Patients each brought to their consultations experiences, beliefs, expectations, and concerns that they wanted the doctor to hear and understand. They were reassured implicitly when it seemed the doctor was taking them seriously and wanted to help; this was also achieved through relationship building and feeling that the GP was readily available to them. However, it was only explicit, informational reassurance that directly addressed patients' concerns by providing them with explanations ruling out serious disease, and helped them to understand and cope with their pain.
The themes of implicit and explicit reassurance uncovered here correspond with ideas of affective and cognitive reassurance, respectively. Although the findings support the use of information and education to alleviate concerns, the role of implicit reassurance through relationship building and empathy remains less clear. The impact of these behaviours on outcomes should form a priority for future research.
在基层医疗中，对于腰痛管理的指南通常推荐给予安慰，但安慰的定义并不明确，其对患者意味着什么也尚不为人知。
探讨腰痛患者在会诊期间如何看待医生的安慰行为。
对来自英国北安普敦郡9家全科医生诊所的患者进行的定性研究。
从全科医疗中招募了23名近期因非特异性腰痛前来就诊的患者。半结构化访谈探讨了他们在会诊期间觉得哪些方面能让人安心，以及会诊后这种安慰的效果。访谈记录采用主题框架法进行分析。
患者在会诊时各自带来了他们希望医生倾听和理解的经历、信念、期望和担忧。当医生似乎认真对待他们并愿意提供帮助时，他们会得到隐性的安慰；这也通过建立医患关系以及感觉全科医生随时可为他们提供帮助来实现。然而，只有明确的、提供信息的安慰，即通过提供排除严重疾病的解释直接解决患者的担忧，并帮助他们理解和应对疼痛。
这里揭示的隐性和显性安慰主题分别与情感性安慰和认知性安慰的概念相对应。尽管研究结果支持利用信息和教育来减轻担忧，但通过建立医患关系和同理心进行隐性安慰的作用仍不太明确。这些行为对治疗结果的影响应成为未来研究的重点。
