Table 3 Study characteristics of included studies
| Â | Reference | Design | Intervention (features) | Mode of Delivery | Outcomes | Evaluative factors |
|---|---|---|---|---|---|---|
1 | Abrahamsen et al. (2022) [29] | Qualitative | The ICIT (Individual Challenge Inventory Tool): A conversational tool with elements of CBT Underpinned by Bandura’s Social Learning Theory | Blended learning 18 h over 4 days in an 8-week period Video, theory, role play, video consultation reviews (healthcare practitioners reviewing their own consultations) | Primary HCPs: Focus group feedback. Analysed using Manual Analysis Secondary n/a | The conversation tool helped structure consultation; patients achieved sense of control (viewed as an important self-help tool); useful to help patients reflect on positives, rather than limitations |
2 | Frostholm et al. (2005) [21] | RCT | The Extended Reattribution Model (TERM): A multifaceted educational programme for the assessment, treatment, and management of PPS | Blended learning 16 h over 2 days  + 3–4 evening courses  + one 2-h booster meetings after 6 months Theoretical presentations covering PPS conceptualisations, etiology and epidemiology, patients’ illness beliefs, and iatrogenic factors Skills training via video supervision | Primary PSCQ-7 Secondary HCP questionnaire IPQ SCL-8 WI-7 SCL-90 SCL-SOM CAGE-4 | n/a |
3 | Houwen et al. (2022) [30] | Mixed Methods | Intervention Mapping Framework: A systemically developed communication training programme Steps 1: Needs assessment; 2: Formulate change objectives; 3: Methods and applications; 4: Develop programme; 5: Implementation; 6: Evaluation | Blended learning 6 h over 2 days  + 7 × 45–60-min online modules Online modules Awareness, attitudes, knowledge, assessment, and treatment of PPS, psychological treatment (optional), collaboration with other HCPs Face-to-face Role play focusing on attitude, exploration and shared understanding of PPS including empathy and psychosocial issues, explanations and taking control | Primary Quantitative: SE-12 Qualitative: Interviews Secondary n/a | HCPs appreciative of the blended learning delivery of the programme Online course good theoretical preparation for in-person training days HCPs reported the e-learning to be extensive and time consuming |
4 | Cross-sectional | The Extended Reattribution Model: A communication programme to provide a simple three stage psychological explanation for PPS through negotiation Main aspects included: symptom, psychosocial issue, and identifying physical or temporal mechanism that links symptoms and psychosocial issue(s) | In-person only Three 2-h sessions Was four in previous trial but reduced to 3 as there was a 51% drop-out rate Overall, the training included: Skills, attitude, and knowledge of PPS; Improving ability to recognise patient’s problems (e.g., worry of symptoms, emotions); Explain how problem(s) are linked to symptoms; Patient-centred approach; Order of fewer referrals, investigations, and drugs; Increased active treatment of mental disorder Role play to practice skills | 2006 HCP: 1 feasibility questionnaire 2007, 2010 HCPs: 2 × Assessed audio transcriptions of GP/patient consultations Transcripts scored on a 5-point Likert scale measured by how consistent GPs’ communication was in line with reattribution Transcripts were scored on a 5-point Likert scale observing the frequency of psychosocial chatter. Scoring was guided by the Liverpool Clinical Interaction Analysis Scheme (LCIAS) | 2006 New learning achievements following training: 48% better or alternative ways of making the link 22% provision of structure to consultations 18% more confidence to openly discuss PPS with patients 2007, 2010 n/a | |
5 | Schaefert et al. (2013) [33] | RCT | Specific Collaborative Group Intervention: A patient group intervention focused on an interpersonal approach with psychodynamic factors All GPs were training in the diagnosis and management of PPS, then split off into the IG or CG. Difference between groups: In the IG, the GP was working in collaboration with a psychodynamic specialist; specialist input was minimal | In-person only 15.5Â h over 2 evenings and 1Â day Focus: Attitudes, treatment, knowledge, and skills around PPS; an interpersonal perspective and the use of patient-centred communication to build a sustainable working alliance; illness beliefs, the biopsychosocial model, using treatment tools, and supporting the use of active coping skills were also covered Group discussions and role play were enacted based on patient-centred communication | Primary Patients: SF-36 (specifically the Physical Composite Score at 12Â months) Secondary SF-36 (specifically the Mental Composite Score at 12Â months) Clinical symptoms Psychosocial distress Healthcare utilisation PHQ-15 PHQ-9 PHQ anxiety module PHQ panic module PHQ psychosocial stress measure WI-7 Use of antidepressants Patient-reported visits to medical specialist Medical Assessment Questionnaire | n/a |
6 | Weiland et al. (2015) [22] | RCT | An evidence-based communication programme using techniques from CBT to improve HCP interviewing, information-giving, and planning skills in PPS consultations | In-person only 14 h over 4 sessions in a 4–6-week period Educational, practical, and video consultation reviews (healthcare practitioners reviewing their own consultations) Sessions covered providing plausible explanations for PPS including making a link between interrelated factors that reinforced condition i.e., symptoms, cognitions, emotions, behaviour, and social factors; and avoiding unnecessary diagnostic testing Skills practice focused on patient centred communication to explore biopsychosocial factors, reassuring patients, and managing expectations | HCPs: Assessed audio transcriptions of GP/patient consultations Transcripts were scored on a 5-point Likert scale observing the application of PPS-focused communication skills. Scoring was guided by an adapted version of the Four Habit Coding Scheme | n/a |