Training Medical Specialists in Communication about MUPS: Patient Outcomes from a RCT

[Dolphin]

These sorts of interventions tend to annoy me as they usually involve things like graded activity.
So I'm happy enough it didn't work out for them.


http://www.ijpcm.org/index.php/IJPCM/article/view/490

Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial

Anne Weiland, Annette H Blankenstein, Jan L Van Saase, Henk T Van der Molen, David Kosak, René M Vernhout, Lidia R Arends

Abstract

Objectives: Medically unexplained physical symptoms (MUPS) burden patients in their well-being and functioning and have a prevalence of approximately 25-50% in primary and specialist care. Medical specialists often find patients with unexplained symptoms difficult to deal with, whereas patients are not always understood. We report effects on patient outcomes of an evidence-based MUPS-focused communication training for medical specialists.

Methods: In a multi-center randomized controlled trial medical specialists and residents allocated to the intervention received a 14-hour MUPS-focused communication training. They practiced a patient-centered approach, including multi-factorial symptom exploration and explanation of MUPS with perpetuating factors. To study intervention effects, each doctor had to include three MUPS patients before and three after the intervention and to ask them to complete questionnaires at baseline and at 3 and 6 months follow-up. The questionnaires included illness worries (Whitely Index), symptom severity (Visual Analogue Scale), distress, depression, anxiety and somatization (4DSQ) and daily functioning (SF-36).

Results: A sufficient number of 123 medical specialists and residents participated in the study. They included 478 MUPS patients. Out of them, 297 patients filled out questionnaires at baseline, 165 patients at 3-months follow-up and 71 patients at 6-months follow-up. Recruitment of patients was lower than expected and patients’ non-response to baseline and follow-up questionnaires was higher than estimated. No significant effects were found on patient outcomes.

Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered. New research with special attention to patient recruitment and retention is needed to answer this question.

Keywords

Medically unexplained physical symptoms; randomized controlled trial; patient reported outcomes; costs; training programme; medical specialists.

References (continue reading here.)

DOI: http://dx.doi.org/10.5750/ijpcm.v6i1.490

 

[Bob]

Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered.

I wonder if that issue would have been so prominent in the conclusion if the results had been positive?

Recruitment of patients was lower than expected...

Sensible patients!

 

[Luther Blissett]

They lost 85% of patients who were willing to answer a questionnaire during 6 months?

Is this kind of drop within what we would expect to see? It seems steep to me, considering the patients agreed to be part of the research.

 

[meandthecat]

I wonder how the ME centres fare with their attempts to 'explain' the symptoms of sufferers? In my own experience the group that I was in shed 77% of participants by the 3rd week and I threw the follow-up questionnaires in the bin.

Perhaps a more honest research topic would be..... How sick and desperate do you have to be to swallow B.S ?

 

[Esther12]

Looks like this was done as part of a phd, available here:

repub.eur.nl/pub/78687/150930_Weiland-Anne.pdf

Conclusion
We found no significant effects of training medical specialists in MUPS communication
on patients’ health and costs. The power was low, most likely due to inadequate patient
information, low literacy and low motivation. To enhance patient response rates we recommend
the use of a patient platform to discuss methods and implementation before
and during the trial.

This paper from the same person uses the fact that training led to clinicians acting how the trainers wanted to claim:

MUPS-focused communication training increases the interviewing and information-giving skills of medical specialists. We recommend that the training is incorporated in postgraduate education for medical specialists and residents who frequently encounter patients with MUPS.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575077/

Never mind the fact that there was no evidence this actually benefited anyone.

The thesis talk about blinded assessment of doctor's letter to patients being helpful to avoid problems with bias, but no mention of problems with bias in the patient's self-assessment of symtoms.

This is the thesis conclusion:

Concluding remarks

With this thesis we have made a contribution to the knowledge of doctor-patient communication
in everyday practice consultations with MUPS patients in somatic specialist
care. Through our studies we have designed an effective communication training for
medical specialists and residents encountering MUPS patients and improved the
exchange of valid information from specialist care to general practice. Our study contributes
to a better understanding of MUPS patients and provides medical specialists
and residents with optimal knowledge, skills and confidence in their encounters with
patients suffering from physical symptoms with an unknown aetiology.

Great work.

 

[medfeb]

These sorts of interventions tend to annoy me as they usually involve things like graded activity.

These kinds of studies drive me crazy because they are based on an unproven and unprovable hypothesis that all people with medically unexplained symptoms will respond to treatment in the same way. Its ridiculous to think that treatment response can be predicted based on the state of our current medical knowledge