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Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care
Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care

Background Previous studies have identified issues with the doctor-patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms. Aim To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU). Design and setting This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fiftytwo participants took part in semi-structured interviews post-treatment in UK primary and secondary care. Method Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data. Results Two key themes were identified: Perceived paucity of GPs' IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: Reaching a 'last-resort diagnosis'; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour. Conclusion In this refractory IBS group, specific doctor- patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.

Cognitive behavioural therapy, Doctor-patient relations, Irritable bowel syndrome, Qualitative research
0960-1643
e654-e662
Sibelli, Alice
64b9c97c-3cf9-4915-8af0-c40b7805a8f1
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Chalder, Trudie
cb09653b-2c1e-4dfc-bb13-c6e8ca918602
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Windgassen, Sula
6fc97726-5e05-489a-b88d-05de32332b33
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Sibelli, Alice
64b9c97c-3cf9-4915-8af0-c40b7805a8f1
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Chalder, Trudie
cb09653b-2c1e-4dfc-bb13-c6e8ca918602
Bishop, Felicity L.
1f5429c5-325f-4ac4-aae3-6ba85d079928
Windgassen, Sula
6fc97726-5e05-489a-b88d-05de32332b33
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef

Sibelli, Alice, Moss-Morris, Rona, Chalder, Trudie, Bishop, Felicity L., Windgassen, Sula and Everitt, Hazel (2018) Patients' perspectives on GP interactions after cognitive behavioural therapy for refractory IBS: a qualitative study in UK primary and secondary care. British Journal of General Practice, 68 (674), e654-e662. (doi:10.3399/bjgp18X698321).

Record type: Article

Abstract

Background Previous studies have identified issues with the doctor-patient relationship in irritable bowel syndrome (IBS) that negatively impact symptom management. Despite this, little research has explored interactions between GPs and patients with refractory IBS. National guidelines suggest cognitive behavioural therapy (CBT) as a treatment option for refractory symptoms. Aim To explore perceptions of interactions with GPs in individuals with refractory IBS after receiving CBT for IBS or treatment as usual (TAU). Design and setting This qualitative study was embedded within a trial assessing CBT in refractory IBS. Fiftytwo participants took part in semi-structured interviews post-treatment in UK primary and secondary care. Method Inductive and/or data-driven thematic analysis was conducted to identify themes in the interview data. Results Two key themes were identified: Perceived paucity of GPs' IBS knowledge and lack of empathy from GPs, but with acknowledgement that this has improved in recent years. These perceptions were described through three main stages of care: Reaching a 'last-resort diagnosis'; searching for the right treatment through a trial-and-error process, which lacked patient involvement; and unsatisfactory long-term management. Only CBT participants reported a shared responsibility with their doctors concerning symptom management and an intention to reduce health-seeking behaviour. Conclusion In this refractory IBS group, specific doctor- patient communication issues were identified. Increased explanation of the process of reaching a positive diagnosis, more involvement of patients in treatment options (including a realistic appraisal of potential benefit), and further validation of symptoms could help. This study supports a role for CBT-based IBS self-management programmes to help address these areas and a suggestion that earlier access to these programmes may be beneficial.

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Accepted/In Press date: 16 May 2018
e-pub ahead of print date: 30 August 2018
Published date: 1 September 2018
Keywords: Cognitive behavioural therapy, Doctor-patient relations, Irritable bowel syndrome, Qualitative research

Identifiers

Local EPrints ID: 421009
URI: http://eprints.soton.ac.uk/id/eprint/421009
ISSN: 0960-1643
PURE UUID: 9c56869d-baad-4900-b716-b3a498ebbd90
ORCID for Felicity L. Bishop: ORCID iD orcid.org/0000-0002-8737-6662
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403

Catalogue record

Date deposited: 21 May 2018 16:30
Last modified: 20 Aug 2019 04:01

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Contributors

Author: Alice Sibelli
Author: Rona Moss-Morris
Author: Trudie Chalder
Author: Sula Windgassen
Author: Hazel Everitt ORCID iD

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