Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, UK.
Br J Health Psychol. 2019 May;24(2):419-442. doi: 10.1111/bjhp.12361. Epub 2019 Mar 8.
Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner (GP) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved.
A qualitative study design was used. In-depth, semi-structured telephone interviews were conducted with 14 patients and 14 GPs (non-dyadic), recruited from 19 primary care practices.
Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives.
Three main themes were identified. Within these, subthemes from patients', GPs', or shared patient/GP perspectives emerged. The main themes encompassed the following: (1) Change from normal - the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GPs' knowledge was often not reflected in patients' accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated.
Some findings, such as impact, mirror those described in chronic fatigue. New insights into early-stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re-presenting. These highlight the need for better communication and shared understanding. GPs should pre-emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests. Statement of contribution What is already known on this subject? Patients with chronic fatigue retrospectively report lack of understanding from GPs in early stage of illness. Little research has investigated the early stages of the fatigue trajectory. What does this study add? Consequences of an episode of subacute fatigue are similar to those reported for CFS. There is discordance between GPs' positive view of negative tests and patients' need for explanation of symptoms. The length of appointments is a significant barrier for creating shared understanding.
疲劳是初级保健中的常见症状。慢性疲劳研究强调了预防慢性疲劳的重要性，但很少有研究调查疲劳轨迹的早期亚急性阶段（<3 个月）。我们旨在探讨初级保健中亚急性疲劳的患者和全科医生（GP）观点：（1）更好地了解这一阶段的疲劳，（2）探索如何改善管理。
采用定性研究设计。从 19 个初级保健实践中招募了 14 名患者和 14 名全科医生（非对偶）进行了深入的半结构化电话访谈。
对访谈记录进行主题分析。最初，分别分析患者和 GP 的叙述，然后合并主题以确定共同和独立的观点。
确定了三个主要主题。在这些主题中，出现了来自患者、GP 或患者/GP 共同观点的子主题。主要主题包括：（1）正常状态的改变-疲劳的影响；（2）管理疲劳的挑战；（3）GP 的知识咨询往往没有反映在患者的叙述中，即使是那些报告积极体验的患者，这表明知识没有得到有效转化。
一些发现，如影响，与慢性疲劳中描述的相似。对早期疲劳管理的新见解也出现了，包括患者和 GP 对阴性测试和不再出现的看法不一致。这凸显了更好沟通和共同理解的必要性。GP 应该预先呈现疲劳的生物心理社会模型，并保持沟通渠道畅通，尤其是在生理测试呈阴性的情况下。
关于这个主题，目前已知的内容是什么？患有慢性疲劳的患者回顾性地报告说，在疾病的早期阶段，他们没有得到 GP 的理解。很少有研究调查疲劳轨迹的早期阶段。这项研究增加了什么？亚急性疲劳发作的后果与报告的慢性疲劳综合征相似。GP 对阴性测试的积极看法与患者对症状解释的需求之间存在差异。预约时间的长短是建立共同理解的一个重要障碍。
