Table 5 Summary of the included studies results
| Â | Study | Intervention and design | Outcome summary | Notes for intervention development |
|---|---|---|---|---|
1 | Abrahamsen et al. (2022) [29] | The Individual Challenge Inventory Tool (ICIT) Qualitative | Themes: 1) The ICIT to facilitate structured consultations: helped to sort out, clarify, substantiate, and concretise patients’ issues 2) HCPs perception of the patient’s experience: activity plan helped patients achieve a sense of control; an important self-help tool; gave HCPs something specific to offer patients 3) The ICIT as a tool to scope assessment of sick leave and treat patient, and encourages patients to reflect on positives, rather than limitations 4) Short-comings and challenges using the ICIT: HCPs identified importance of activity plan; demand characteristics of patients to meet HCPs expectations; one patient – ICIT trivialised symptoms; ICIT useful to refine patient’s challenges, in addition to reflect some responsibility back to the patient | Structured consultations Patient sense of control Self-help tool / something to offer patients Draw on strengths, not focus on limitations Patients to take agency |
2 | Frostholm et al. (2005) [21] | The Extended Reattribution Model (TERM) RCT | Primary outcomes • Patient satisfaction higher when consulting trained HCP - Particularly when feeling uncertain about their health problem Patient predictors (higher chance of dissatisfied patients) • High illness worries • High symptomology • Higher levels of emotional distress • Patients’ illness perceptions (negative emotional representation, high levels of uncertainty, perceived negative consequences, long timeline perspective) • Psychosocial issues (feeling down, worried, state of mind, problems in family, personality) | Important to think about patients holistically i.e., psychological/emotional distress Psychosocial issues should be embedded within consultations |
3 | Houwen et al. (2022) [30] | Intervention Mapping Framework Mixed methods | Self-efficacy (assessed at three time points) • Significant increase in scores across all time points Qualitative feedback 1) Benefit of training programme: e-learning good theoretical practice for in-person training days; and education that integrates e-learning and face-to-face learning needs 2) Acquisition of skills: learning to conduct thorough exploration of patient’s symptoms; more aware of attitudes and language used, importance of shared understanding, introduced to several explanatory models, improve referral letters 3) Recommendations for training adaptations: HCPs still experience difficulties providing plausible explanations – more time practicing this in face-to-face sessions; e-learning extensive and time consuming (max 420 min / 7 h) | Blended learning useful to incorporate theory (online) and skills practice (in-person) In-person to focus on explaining explanatory models and creating a shared understanding of symptoms Short and concise pre-workshop modules |
4 | Morriss et al. (2006)Â [31] | The Extended Reattribution Model (TERM) Quantitative | One single feasibility questionnaire - 33% training very useful in their job - 44% training useful in their job - 15% unsure of how useful the training was - 8% training had very little use - 82% felt confident or very confident in managing patients with PPS after training - 18% uncertain or unchanged in confidence - 44% training methods helpful - 48% training methods very helpful (except one specific aspect of course -not specified in results) - 8% training methods unhelpful - 18% longer course to practice role play - 18% chance to discuss difficult cases and techniques New learning achievements - 48% better or alternative ways of making the link between interrelated factors - 22% provision of structure to consultations - 18% more confident to openly discuss PPS with patients | Making the link between interrelated factors Focus on explaining explanatory models Identifying a structure to consultations HCPs would benefit from the opportunity to discuss difficult cases |
5 | Morriss et al. (2007) [32] | The Extended Reattribution Model (TERM) RCT | Substantial improvements were shown in the training group in terms of doctor-patient communication consistent with the TERM model. HCPs explored factors such as health beliefs, making the link explanations, and feeling understood chatter more than the controls Secondary outcomes – TERM associated with - Non-significant improved patient satisfaction - Higher proportion of patients felt they knew the cause of their symptoms; endorsed an emotional cause - Worse self-rating of overall health, higher cases of anxiety, beliefs health issues may last longer, health consequences will be more serious and less under the patient’s control - No effects on psychological wellbeing (depression, health anxiety) or use of healthcare resources | Making the link between interrelated factors to explain symptoms |
6 | Morriss et al. (2010) [20] | The Extended Reattribution Model (TERM) RCT | Psychosocial chatter after TERM training: - Substantial increase in GP prompt for psychosocial information concerning symptoms - Increase in patients prompting psychosocial information - Did not increase GP to explore psychosocial disclosures further - Increased GPs provision of psychosocial explanation - Decreased GP advocation for somatic intervention - GPs speech: average of 6 utterances concerning the appropriateness of somatic intervention and an average of 2 utterances of psychosocial explanation - Increased patients’ disclosure of psychosocial problems - Approx. 50% patients disclosed a new psychosocial problem - 25% patients in IG: 2 or more utterances of psychosocial disclosures, 10 or more elaborating on psychosocial disclosure, 4 or more utterances of psychosocial explanation for their PPS | Psychosocial stressors an important consideration in consultations – i.e., holistic assessment |
7 | Schaefert et al. (2013) [33] | Special Collaborative Group Intervention (speciAL) RCT | Primary outcome: SF-36 (PSC at 12 months) - Non-significant improvements in both groups; great improvements in IG (but very little) - Physical functioning significant at 12 months - Somatic symptom severity improved at 6 months (significant), lasted to 12 months but no longer significant Secondary outcomes: SF-36 (MCS) - Significant improvements in both groups; larger improvements in IG (55% IG versus 34% CG) - Improved by 4-points or more on MCS (used as threshold to determine clinical change for PPS in primary care - At 12 months: vitality and emotional functioning significant Less psychosocial distress, less health anxiety Healthcare resource utilisation: Number of visits to GP or medical specialists decreased in both groups, significant in IG group; use of antidepressants lower in IG group compared to CG – declined over time in both groups but only reach significance in IG at 6 months) | Aim of the intervention was to improve patient coping with persistent physical symptoms – understanding and accepting symptoms likely explain areas of improvement |
8 | Weiland et al. (2015) [22] | An evidence-based communication programme using techniques from CBT RCT | Trained HCPs showed (in comparison to CG): - Larger increase in exploring patient’s cognitions, impact of symptoms on behaviour, environment, and emotions - Worked in a more person-centred way, explained interrelating factors more frequently - No effects for making plans and follow-up appointments - Better interviewing and information-giving skills in PPS consultations HCP feedback: • Training programme useful for daily practice • Scored 2.79 on a 3-poing Likert scale • Exercise skills, literature and during of training reported as useful • Despite useful feedback, HCPs reported consultations with patients from different ethnic backgrounds as extremely difficult (factors: time, professional interpreters, knowledge of cultural diversity) | Engage patients holistically Working in a person-centred way |