East London NHS Foundation Trust (ELFT), London, United Kingdom.
Queen Mary University of London, London, United Kingdom.
BMC Health Serv Res. 2024 Jun 3;24(1):698. doi: 10.1186/s12913-024-11130-9.
Functional somatic symptoms (FFS) and bodily distress disorders are highly prevalent across all medical settings. Services for these patients are dispersed across the health care system with minimal conceptual and operational integration, and patients do not currently access therapeutic offers in significant numbers due to a mismatch between their and professionals' understanding of the nature of the symptoms. New service models are urgently needed to address patients' needs and to align with advances in aetiological evidence and diagnostic classification systems to overcome the body-mind dichotomy.
A panel of clinical experts from different clinical services involved in providing aspects of health care for patients with functional symptoms reviewed the current care provision. This review and the results from a focus group exploration of patients with lived experience of functional symptoms were explored by the multidisciplinary expert group, and the conclusions are summarised as recommendations for best practice.
The mapping exercise and multidisciplinary expert consultation revealed five themes for service improvement and pathway development: time/access, communication, barrier-free care, choice and governance. Service users identified four meta-themes for best practice recommendations: focus on healthcare professional communication and listening skills as well as professional attributes and knowledge base to help patients being both believed and understood in order to accept their condition; systemic and care pathway issues such as stronger emphasis on primary care as the first point of contact for patients, resources to reduce the length of the patient journey from initial assessment to diagnosis and treatment.
We propose a novel, integrated care pathway for patients with 'functional somatic disorder', which delivers care according to and working with patients' explanatory beliefs. The therapeutic model should operate based upon an understanding of the embodied nature of patient's complaints and provide flexible access points to the care pathway.
功能性躯体症状（FFS）和躯体痛苦障碍在所有医疗环境中都非常普遍。针对这些患者的服务分散在整个医疗保健系统中，概念和操作上几乎没有整合，由于患者和专业人员对症状性质的理解存在差异，患者目前无法大量获得治疗服务。迫切需要新的服务模式来满足患者的需求，并与病因学证据和诊断分类系统的进展保持一致，以克服身心二分法。
来自不同临床服务部门的一组临床专家参与了为有功能性症状的患者提供医疗保健的各个方面，他们审查了当前的护理服务。该审查以及对有功能性症状患者实际体验的焦点小组探索的结果，由多学科专家小组进行了探讨，结论总结为最佳实践建议。
映射练习和多学科专家咨询揭示了服务改进和途径发展的五个主题：时间/途径、沟通、无障碍护理、选择和治理。服务使用者确定了最佳实践建议的四个元主题：重点关注医疗保健专业人员的沟通和倾听技巧以及专业属性和知识库，以帮助患者被相信和理解，从而接受他们的病情；系统性和护理途径问题，如更加重视初级保健作为患者的第一联系点、减少从初步评估到诊断和治疗的患者就诊路径的资源。
我们为“功能性躯体障碍”患者提出了一种新颖的综合护理途径，根据和按照患者的解释性信念提供护理。治疗模型应基于对患者投诉的身体性质的理解，并为护理途径提供灵活的接入点。
