The online version of this article (doi:10.1186/1471-2296-15-73) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
EG was involved in the design of the study, in the collection, analysis and interpretation of the data and drafted the manuscript. WV was involved in the design of the study and in the analysis and interpretation of the data and critically revised the manuscript. AM contributed to the data collection and analysis and was involved in drafting the manuscript. FB was involved in the interpretation of the data and critically revised the manuscript. TvdW and CvdV contributed to the design of the study and critically revised the manuscript. All authors read and approved the final manuscript.
Many patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients’ worries, cognitions underlying reassurance and factors supporting patients’ reassuring cognitions.
In a qualitative study, we conducted stimulated recall interviews with 21 patients of 12 different GPs shortly after their consultation. We selected consultations in which the GPs aimed to reassure worried patients and used their videotaped consultation as a stimulus for the interview. The interviews were analysed with thematic coding and by writing interpretive summaries.
Patients expressed four different core cognitions underlying their concerns: ‘I have a serious illness’, ‘my health problem will have adverse physical effects’, ‘my treatment will have adverse effects’ and ‘my health problem will negatively impact my life’. Patients mentioned a range of person-specific and context-specific cognitions as reasons for these core cognitions. Patients described five core reassuring cognitions: ‘I trust my doctor’s expertise’, ‘I have a trusting and supporting relationship with my doctor’, ‘I do not have a serious disease’, ‘my health problem is harmless’ and ‘my health problem will disappear.’ Factors expressed as reasons for these reassuring cognitions were GPs’ actions during the consultation as well as patients’ pre-existing cognitions about their GP, the doctor-patient relationship and previous events. Patients’ worrying cognitions were counterbalanced by specific reassuring cognitions, i.e. worrying and reassuring cognitions seemed to be interrelated.
Patients described a wide range of worrying cognitions, some of which were not expressed during the consultation. Gaining a thorough understanding of the specific cognitions and tailoring reassuring strategies to them should be an effective way of achieving reassurance. The identified reassuring cognitions can guide doctors in applying these strategies in their daily practice.
Barry CA, Bradley CP, Britten N, Stevenson FA, Barber N: Patients’ unvoiced agendas in general practice consultations: qualitative study. Br Med J (Clin Res Ed). 2000, 320: 1246-1250. 10.1136/bmj.320.7244.1246. CrossRef
Lucock MP, Morley S, White C, Peake MD: Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey. Br Med J (Clin Res Ed). 1997, 315: 572-575. 10.1136/bmj.315.7108.572. CrossRef
Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR: Can 40 seconds of compassion reduce patient anxiety?. J Clin Oncol. 1999, 17: 371-379. PubMed
Liénard A, Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J, Etienne A-M, Klastersky J, Reynaert C, Scalliet P, Slachmuylder JL, Razavi D: Factors that influence cancer patients’ anxiety following a medical consultation: impact of a communication skills training programme for physicians. Ann Oncol. 2006, 17: 1450-1458. 10.1093/annonc/mdl142. CrossRefPubMed
Warwick HM, Salkovskis PM: Reassurance. Br Med J (Clin Res Ed). 1985, 290: 1028-10.1136/bmj.290.6474.1028. CrossRef
McDonald IG, Daly J, Jelinek VM, Panetta F, Gutman JM: Opening Pandora’s box: the unpredictability of reassurance by a normal test result. Br Med J (Clin Res Ed). 1996, 313: 329-332. 10.1136/bmj.313.7053.329. CrossRef
Petrie KJ, Müller JT, Schirmbeck F, Donkin L, Broadbent E, Ellis CJ, Gamble G, Rief W: Effect of providing information about normal test results on patients’ reassurance: randomised controlled trial. Br Med J (Clin Res Ed). 2007, 334: 352-10.1136/bmj.39093.464190.55. CrossRef
Donovan JL, Blake DR: Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: “just a touch of arthritis, doctor?”. Br Med J (Clin Res Ed). 2000, 320: 541-544. 10.1136/bmj.320.7234.541. CrossRef
Lapane KL, Dubé CE, Schneider KL, Quilliam BJ: Misperceptions of patients vs providers regarding medication-related communication issues. Am J Manag Care. 2007, 13: 613-618. PubMed
Diefenbach MA, Leventhal H: The common-sense model of illness representation: Theoretical and practical considerations. J Soc Distress Homeless. 1996, 5 (1): 11-38. 10.1007/BF02090456. CrossRef
Leventhal H, Leventhal EA, Contrada RJ: Self-regulation, health, and behavior: a perceptual-cognitive approach. Psychol Health. 1998, 13: 717-733. 10.1080/08870449808407425. CrossRef
Lyle J: Stimulated recall: a report on its use in naturalistic research. Br Educ Res J. 2003, 29: 861-878. 10.1080/0141192032000137349. CrossRef
Tracy SJ: Qualitative quality: eight big-tent criteria for excellent qualitative research. Qual Inq. 2010, 16 (10): 837-851. 10.1177/1077800410383121. CrossRef
Warwick HMC: Cognitive therapy in the treatment of hypochondriasis. Adv Psychiatr Treat. 1998, 4: 285-291. 10.1192/apt.4.5.285. CrossRef
- “Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews
Trudy van der Weijden
Cees van der Vleuten
- BioMed Central
Neu im Fachgebiet Allgemeinmedizin
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II