Background
Methods
Design
Ethical approval and informed consent
Study context
Selection procedures
The interviews
Data analysis
Results
Data characteristics
Patient | Patients’ rating: concern pre-consultation (0–10) | GPs’ rating: importance reassurance (0–10) | Complaint(s) | Stand-alone/follow-up appointment | Duration consultation(minutes) |
---|---|---|---|---|---|
1 | 10 | 8 | Chest pain | Stand-alone | 16 |
2 | 6 | 8 | Abdominal pain, lower back pain | Follow-up | 9 |
3 | 0 | 8 | Reduced kidney function | Stand alone | 9 |
4 | 6 | 10 | Hypertension, lower back pain | Follow-up | 15 |
5 | 3 | 10 | Stool problems | Follow-up | 8 |
6 | 10 | 10 | Accelerated heartbeat, headache | Follow-up | 19 |
7 | 10 | 10 | Chest pain, headache, hypertension | Stand-alone | 15 |
8 | 0 | 3 | Burn | Stand-alone | 7 |
9 | 1 | 4 | Soar throat | Stand-alone | 7 |
10 | 4 | 7 | Sudden shaking attack, furuncle | Follow-up | 7 |
11 | 7 | 7 | Hypertension, headache, nausea | Stand-alone | 14 |
12 | 2 | 8 | Chest pain | Stand-alone | 13 |
13 | 8 | 7 | Skin mark | Follow-up | 10 |
14 | 4 | 7 | Ankle pain | Stand-alone | 9 |
15 | 10 | 10 | Breast lump, joint pain | Stand-alone | 17 |
16 | 6 | 8 | Burn out, hypertension | Follow-up | 21 |
17 | 1 | 7 | Wrist pain, excessive sweating | Stand-alone | 8 |
18 | 7 | 10 | Hypertension, weight gain | Follow-up | 12 |
19 | 7 | 9 | Hip complaints | Stand-alone | 11 |
20 | 1 | 9 | Urinary problems | Stand-alone | 11 |
21 | 0 | 9 | Leg pain | Stand-alone | 15 |
The interviews
Worrying cognitions and how reassuring cognitions counterbalance them
Worrying core cognitions | Underlying cognitions | |
---|---|---|
Person-specific cognitions | Context-specific cognitions | |
I have a serious disease
| - I have alarming symptoms/abnormal test results which indicate serious disease. | - This is a common disease according to the media/in my family/among my friends and acquaintances. |
- The symptoms I have are not normal. | - The media/my friends say that my symptoms are indicative of a serious disease. | |
- Now that I am getting older the chance of having a serious disease is increasing. | - The symptoms I have must be abnormal as I know of no people in my social environment and with a similar background to mine that have such symptoms. | |
- My symptoms have not disappeared after the treatment so something must be wrong. | ||
My health problem will have adverse physical effects
| - I have a health problem that will lead to serious illness causing disability/additional conditions/death. | - These adverse effects happen all the time according to the media/in my family/among people I know. |
- My symptoms are getting worse. | ||
- I do not know how the symptoms can be treated since I do not know what causes them. | ||
My treatment will have adverse effects
| - The treatment I received was incorrect, so my health problem will persist. | - In my social environment I have seen many cases of incorrect treatment of this problem with bad outcomes. |
- If I take medication, I will have to continue to take it indefinitely/there will be side effects/I will have difficulty sticking to my drug regimen. | - In my social environment I have often seen adverse effects of medication. | |
My health problem will negatively impact my life
| - Having health problems does not fit with how I see myself and my future. | - My social environment is not supportive when I have problems and concerns/does not allow me to deal with the problem in my own way. |
- I have so many health problems at the same time/My health problems are getting worse/my treatment is no longer effective. | ||
- My health problems will make me dependent on others/limit my daily functioning. |
Reassuring core cognitions | Factors supporting reassuring core cognitions | |
---|---|---|
Consultation-specific factors. My doctor: | Context-specific factors. There is: | |
I feel safe and supported because I have a trusting relationship with my doctor.
|
- emphasizes the equality of our relationship by: approaching me in a friendly manner, using humour. |
- an existing trusting doctor-patient relationship based on: the duration of the relationship; I know I can always ask the doctor any question I have; the doctor being always open and honest. |
- shows that he/she is interested in me as a person by: allowing me to tell my story, listening attentively, exploring and understanding my feelings and personal situation. | ||
- shows involvement by: showing empathy; monitoring my condition | ||
I trust my doctor’s judgment since I trust his/her expertise.
|
- obtains a good understanding of my problems and symptoms by: allowing me to tell my story; listening attentively; exploring and summarizing my symptoms/feelings/context; showing/telling me what he/she is typing; referring to the previous consultation. |
- an experienced doctor who: has had many years of experience; sees many patients with problems that are similar to mine; has a good reputation in my neighbourhood. |
- takes the necessary actions to adequately investigate my symptoms by: exploring alarming symptoms; performing a physical examination and other investigations; referring me to a specialist. |
- a familiar doctor who: knows my whole history. | |
- explains the reasons for his/her actions by: announcing and explaining what he/she will do during the physical examination and which further investigations will be done. |
- a careful doctor who: has never made a mistake; has always been quick and effective; has always referred me when it was necessary. | |
- takes care to perform actions properly and thoroughly by: making sure that he/she does not forget anything by sharing findings with me during the examination/when typing during the consultation; discussing test results with me; proposing a good specialist. | ||
I do not have a serious disease
| - underpins why my symptoms are not serious by: explaining (using visual tools) why my symptoms/findings are not consistent with a serious diagnosis; demonstrating how the examination excludes a serious diagnosis; emphasizing that the maximum amount of information has been obtained; pointing out that a specialist will make the same diagnosis. |
- sufficient evidence provided to exclude a serious diagnosis because: multiple examinations, investigations and medical professionals have excluded serious disease. |
- enables me to reassure myself by: exploring alarming symptoms that are not present; ordering tests and investigations of which I can interpret the results. | ||
- underlines (non-)verbally that my symptoms are not serious by: a calm and unconcerned expression; stating that I do not have a serious illness/there is no need to worry/my symptoms are benign. | ||
- shows that actions that might indicate a serious diagnosis are not really necessary by: stating there is no need for illness behaviour; not referring urgently; emphasizing that the purpose of the referral is to re-assure me. | ||
- provides insight into my tendency to worry about physical symptoms by: giving a cause for this tendency that I can recognize and understand, emphasizing the importance of being aware of this tendency. | ||
My health problem is harmless/easy to treat.
|
- gives a logical and understandable explanation for my symptoms by: explaining what causes them; giving an explanation that is consistent with my self-image; linking new symptoms to a benign diagnosis on which we had agreed. | |
- clarifies the cause of my symptoms by: using clear language; talking slowly; checking that I have fully understood the benign diagnosis; using visual tools; sharing findings during the physical examination. | ||
My health problem will: disappear/not return/not deteriorate
|
- ensures I receive adequate treatment by: tailoring the treatment to my wishes and expectations; proposing treatment that I can execute myself; treating the cause of my symptoms; referring me to (a team of) specialists for treatment |
- evidence that I am getting better because: the symptoms are diminishing, the treatment is effective. |
- adequately monitors my condition by: indicating when he/she wants to schedule a follow-up visit/check-up; monitoring my condition him/herself. |
- a doctor who always carefully monitors my condition by: scheduling regular follow-up visits; being available in case of problems between appointments. | |
- gives a positive vision of my future by: outlining the natural course of the disease; emphasizing that everything will be done to ensure a full recovery. |