Making sense of symptoms, clinicians and systems: a qualitative evaluation of a facilitated support group for patients with medically unexplained symptoms

Patient Journey und krankheitsbezogene Nutzung digitaler Medien: Eine Querschnittsstudie unter Dermatologie-Patienten in Deutschland: Patient journey and disease-related digital media usage: A cross-sectional study among dermatology patients across Germany

Hintergrund und Ziele

Ziel dieser Studie war es, die Auswirkungen der Nutzung gesundheitsbezogener digitaler Medien auf die Arzt‐Patienten‐Beziehung und die Patient Journey (Weg des Patienten durch alle Phasen seiner Erkrankung) zu untersuchen, um positive Veränderungen in der dermatologischen Praxis zu bewirken.

Patienten und Methodik

Von Juni bis November 2022 füllten Personen mit Hautkrankheiten in Deutschland einen Fragebogen zur Bewertung der gesundheitsbezogenen Nutzung digitaler Medien, der E‐Health‐Kompetenz, des Einflusses der Nutzung digitaler Medien auf die Arzt‐Patienten‐Beziehung und die Patient Journey sowie soziodemografischer und gesundheitlicher Merkmale aus. Die Daten wurden deskriptiv und mittels linearer Regressionen analysiert.

Ergebnisse

Insgesamt wurden 919 Teilnehmer analysiert (medianes Alter: 47,00, Interquartilsbereich [28,00; 61,00] Jahre, weiblich: 53,6%, Nutzer digitaler Medien im Kontext der Erkrankung: 56,8%). Google und Online‐Enzyklopädien wurden am häufigsten vor und nach der dermatologischen Konsultation genutzt. Online‐Selbsthilfegruppen wurden von 76,3% der nicht behandelten Teilnehmer in Anspruch genommen. Die Nutzung digitaler Medien hatte keinen Einfluss auf die Arzt‐Patienten‐Beziehung und wirkte sich positiv auf die Patient Journey aus. Positive Auswirkungen wurden mit höherer E‐Health‐Kompetenz, Zufriedenheit mit der Qualität digitaler Medien, Bedeutung digitaler Medien, ländlichem Wohnsitz, höherem Bildungsniveau und Vertrauen in Dermatologen in Verbindung gebracht.

Schlussfolgerungen

Die dermatologische Versorgung in Arztpraxen kann vom Potenzial digitaler Gesundheitsmedien profitieren. Eine evidenzbasierte digitale Gesundheitsplattform ist erforderlich, um die E‐Health‐Kompetenz der Betroffenen zu erhöhen und ihre Zufriedenheit mit der Qualität digitaler Medien zu verbessern.

Patient journey and disease-related digital media usage: A cross-sectional study among dermatology patients across Germany

BACKGROUND AND OBJECTIVES

This study aimed to fill the gap of evidence-based data by examining the impact of health-related digital media use's impact on the patient-physician relationship and patient journey, with the goal of driving positive changes in office-based dermatological practice.

PATIENTS AND METHODS

German individuals with skin conditions completed a questionnaire assessing health-related digital media use, eHealth literacy, impact of digital media use on the patient-physician relationship and patient journey, and sociodemographic and health characteristics from June to November 2022, followed by descriptive analysis and linear regressions.

RESULTS

Overall, 919 participants were analyzed (median age: 47.00, interquartile range [28.00; 61.00] years, female: 53.6%, health-related digital media users: 56.8%). Google and online encyclopedias were commonly used before and after dermatological consultations. Online self-help groups were used by 75% of non-treated participants. Digital media use had no impact on the patient-physician relationship and a positive impact on the patient journey. Positive impacts were associated with higher eHealth literacy, satisfaction with digital media quality, importance of digital media, rural residence, high education, and trust in dermatologists.

CONCLUSIONS

The potential of health-related digital media in office-based dermatological care necessitates the drive of an evidence-based digital health platform to improve eHealth literacy and satisfaction with the quality of digital media among affected individuals.

'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness

Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.

Knowing the entire story – a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease)

Background

Healthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients’ experiences with CLD & CLD-related care, identify themes and repertories in these patients’ narrations, and provide potential ways to improve communication with them.

Methods

Informed by the principles of ‘clean language’, we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes.

Results

Participants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as ‘invisible’ to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal ‘you’ and other forms of presupposition).

Conclusion

Central themes found in CLD patients’ communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.

Perceived working mechanisms of psychosomatic therapy in patients with persistent somatic symptoms in primary care: a qualitative study

OBJECTIVES

To explore the perceived working mechanisms of psychosomatic therapy according to patients with persistent somatic symptoms (PSS) and their psychosomatic therapists.

DESIGN

Qualitative study using semistructured face-to-face interviews and focus groups. All interviews were audiorecorded, transcribed verbatim and analysed, by two researchers independently, based on the thematic analysis.

SETTING

Alongside a randomised controlled trial to establish the (cost-)effectiveness of psychosomatic therapy in patients with PSS in primary care, we conducted a process evaluation with a qualitative study. Patients were recruited in general practice in three regions in the Netherlands.

PARTICIPANTS

Interviews were conducted with twenty patients with PSS who received psychosomatic therapy and 25 psychosomatic therapists. In addition, two focus groups were conducted with six and seven psychosomatic therapists, respectively.

INTERVENTION

Psychosomatic therapy, delivered by specialised exercise and physical therapists, is a multimodal and tailored treatment based on the biopsychosocial model.

OUTCOME MEASURES

Experiences, opinions and views from patients' and therapists' perspective on psychosomatic therapy were identified.

RESULTS

A total of 37 interviews with patients, 25 interviews and two focus groups with therapists were analysed. Three main themes emerged from the data of the patients: (1) continuous alternation of psychosocial conversations and body-oriented exercises; (2) awareness of body-mind connection and (3) good relationship with therapist. Four main themes emerged from the data of the therapists (1) building rapport; (2) continuously searching for common ground; (3) making patients aware of the interaction between body and mind; and (4) continuous alternation between exploration and treatment.

CONCLUSION

According to patients as well as therapists, the continuous alternation of psychosocial conversations and body-oriented exercises to provide awareness of the interaction between body and mind are the perceived working mechanism of psychosomatic therapy. Therapeutic alliance and finding common ground between patient and therapist are prerequisites for the success of psychosomatic therapy.

TRIAL REGISTRATION NUMBER

NL7157 (NTR7356).