在全科医学中针对医学无法解释的症状的沟通干预措施：随机对照试验的系统评价和荟萃分析。
Communication interventions for medically unexplained symptom conditions in general practice: A systematic review and meta-analysis of randomised controlled trials.
机构信息
Department of Health Sciences, York Trials Unit, University of York, Heslington, York, United Kingdom.
Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom.
出版信息
PLoS One. 2022 Nov 14;17(11):e0277538. doi: 10.1371/journal.pone.0277538. eCollection 2022.
BACKGROUND
Medically unexplained symptoms (MUS) account for 3-50% of all General Practitioner (GP) consultations and are difficult to diagnose due to their unknown aetiology, symptom overlap between conditions, and lack of effective treatment options. MUS patients' and primary care clinicians frequently face challenges during consultations, with GPs reporting difficulty identifying and classifying MUS, whilst patients report stigma and feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS.
AIM
This systematic review aims to evaluate the effectiveness of primary care based communication interventions at improving MUS patients' and/or clinician outcomes.
METHOD
Four electronic databases were searched from inception to November 2021. Two researchers independently undertook screening, data extraction and quality appraisal. Given the heterogeneous nature of the studies identified, narrative syntheses were conducted, along with meta-analyses where possible to pool data.
RESULTS
9 papers from 10 Randomised Controlled Trials were included. The included studies displayed considerable risk of bias and poor reporting. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (such as reattribution) could improve pain, mental and physical functioning whilst reattribution training may improve clinician confidence treating MUS. However, methodological limitations mean that these findings should be interpreted with caution.
CONCLUSION
A range of interventions for improving communication with MUS patients in primary care have been evaluated. However, the heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. Before considering further randomised controlled trials researchers should focus on developing a new or modified communication intervention for MUS patients and their clinicians.
TRAIL REGISTRATION
The systematic review was prospectively registered with PROSPERO (registration record CRD42020206437).
背景
医学无法解释的症状（MUS）占全科医生（GP）咨询的 3-50%，由于其病因不明、症状在疾病之间重叠以及缺乏有效治疗选择，因此难以诊断。MUS 患者和初级保健临床医生在咨询中经常面临挑战，全科医生报告难以识别和分类 MUS，而患者则报告受到耻辱感和被临床医生视为不合法。沟通干预措施已被提议作为一种促进医患关系和帮助管理 MUS 的方法。
目的
本系统评价旨在评估基于初级保健的沟通干预措施在改善 MUS 患者和/或临床医生结局方面的有效性。
方法
从成立到 2021 年 11 月，四个电子数据库被搜索。两名研究人员独立进行筛选、数据提取和质量评估。鉴于确定的研究具有异质性，因此进行了叙述性综合分析，并在可能的情况下进行了荟萃分析以汇总数据。
结果
从 10 项随机对照试验中纳入了 9 篇论文。纳入的研究存在较大的偏倚风险和报告质量差。一些有限的证据表明，针对 MUS 量身定制的沟通干预措施（而不是遵循预定模式）可以改善疼痛、心理和身体功能，而归因训练可能会提高临床医生治疗 MUS 的信心。然而，由于方法学上的限制，这些发现应谨慎解释。
结论
已经评估了一系列用于改善初级保健中 MUS 患者沟通的干预措施。然而，现有证据的异质性和研究质量差意味着我们不能确定这些干预措施是否有效。在考虑进一步的随机对照试验之前，研究人员应专注于为 MUS 患者及其临床医生开发新的或改进的沟通干预措施。
试验注册
该系统评价已在 PROSPERO （注册记录 CRD42020206437）上进行了前瞻性注册。
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