Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
Health Expect. 2019 Jun;22(3):338-347. doi: 10.1111/hex.12854. Epub 2018 Dec 30.
It is unknown whether patients with medically unexplained symptoms (MUS) differ from patients with medically explained symptoms (MES) regarding their expectations and experiences on task-oriented communication (ie, communication in which the primary focus is on exchanging medical content), affect-oriented communication (ie, communication in which the primary focus is on the emotional aspects of the interaction) and therapy-oriented communication (ie, communication in which the primary focus is on therapeutic aspects) of the consultation and the extent to which GPs meet their expectations.
This study aims to explore (a) differences in patients' expectations and experiences in consultations with MUS patients and patients with MES and (b) the influence of patients' experiences in these consultations on their post-visit anxiety level.
Prospective cohort.
Eleven Dutch general practices.
Patients completed the QUOTE-COMM (Quality Of communication Through the patients' Eyes) questionnaire before and after the consultation to assess their expectations and experiences and these were related to changes in patients' state anxiety (abbreviated State-Trait Anxiety Inventory; STAI).
Expectations did not differ between patients with MUS and MES. Patients presenting with either MUS or MES rated their experiences for task-related and affect-oriented communication of their GP higher than their expectations. GPs met patients' expectations less often on task-oriented communication in MUS patients compared to MES patients (70.2% vs 80.9%; P = ˂0.001). Affect-oriented communication seems to be most important in reducing the anxiety level of MUS patients (β -0.63, 95% Cl = -1.07 to -0.19).
Although the expectations of MUS patients are less often met compared to those of MES patients, GPs often communicate according to patients' expectations. Experiencing affect-oriented communication is associated with a stronger reduction in anxiety in patients with MUS than in those with MES.
GPs communicate according to patients' expectations. However, GPs met patients' expectations on task-oriented communication less often in patients with MUS compared to patients with MES. Experiencing affect-oriented communication had a stronger association with the post-consultation anxiety for patients with MUS than MES.
目前尚不清楚患有医学无法解释症状（MUS）的患者与患有医学可解释症状（MES）的患者在以任务为导向的沟通（即主要关注交换医学内容的沟通）、以情感为导向的沟通（即主要关注互动情感方面的沟通）和以治疗为导向的沟通（即主要关注治疗方面的沟通）方面的期望和体验是否存在差异，以及全科医生在多大程度上满足了他们的期望。
本研究旨在探讨（a）患有 MUS 患者和 MES 患者的期望和体验方面的差异，以及（b）患者在这些咨询中的体验对其就诊后焦虑水平的影响。
前瞻性队列研究。
荷兰 11 家全科诊所。
患者在就诊前后完成 QUOTE-COMM（通过患者视角评估沟通质量）问卷，以评估他们的期望和体验，这些与患者状态焦虑（缩写为状态-特质焦虑量表；STAI）的变化相关。
患有 MUS 和 MES 的患者的期望没有差异。患有 MUS 或 MES 的患者对他们的全科医生的与任务相关的和以情感为导向的沟通体验的评价高于他们的期望。与 MES 患者相比，全科医生在 MUS 患者的以任务为导向的沟通中较少满足患者的期望（70.2%对 80.9%；P<0.001）。以情感为导向的沟通似乎对降低 MUS 患者的焦虑水平最为重要（β=-0.63，95%Cl=-1.07 至-0.19）。
尽管与 MES 患者相比，MUS 患者的期望较少得到满足，但全科医生通常会根据患者的期望进行沟通。体验以情感为导向的沟通与 MUS 患者就诊后焦虑的降低幅度比 MES 患者更强相关。
全科医生会根据患者的期望进行沟通。然而，与 MES 患者相比，全科医生在 MUS 患者的以任务为导向的沟通中较少满足患者的期望。体验以情感为导向的沟通与 MUS 患者就诊后焦虑的相关性比 MES 患者更强。
