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Subacute fatigue in primary care – two sides of the story

Subacute fatigue in primary care – two sides of the story
Subacute fatigue in primary care – two sides of the story

Objectives: Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner (GP) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved. Design: A qualitative study design was used. In-depth, semi-structured telephone interviews were conducted with 14 patients and 14 GPs (non-dyadic), recruited from 19 primary care practices. Methods: Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives. Results: Three main themes were identified. Within these, subthemes from patients’, GPs’, or shared patient/GP perspectives emerged. The main themes encompassed the following: (1) Change from normal – the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GPs’ knowledge was often not reflected in patients’ accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated. Conclusions: Some findings, such as impact, mirror those described in chronic fatigue. New insights into early-stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re-presenting. These highlight the need for better communication and shared understanding. GPs should pre-emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests. Statement of contribution What is already known on this subject? Patients with chronic fatigue retrospectively report lack of understanding from GPs in early stage of illness. Little research has investigated the early stages of the fatigue trajectory. What does this study add? Consequences of an episode of subacute fatigue are similar to those reported for CFS. There is discordance between GPs’ positive view of negative tests and patients’ need for explanation of symptoms. The length of appointments is a significant barrier for creating shared understanding.

fatigue, primary care, qualitative
1359-107X
1-24
Hulme, Katrin
9d03cea4-ba29-4255-b852-7005f1180e5c
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Burrows, Abigail
a0c4eed4-afca-4089-adaa-a5207491c2fc
Julia, Anna
e465e112-83aa-49a4-845a-29a71c45fce6
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e
Hulme, Katrin
9d03cea4-ba29-4255-b852-7005f1180e5c
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Burrows, Abigail
a0c4eed4-afca-4089-adaa-a5207491c2fc
Julia, Anna
e465e112-83aa-49a4-845a-29a71c45fce6
Moss-Morris, Rona
a502f58a-d319-49a6-8aea-9dde4efc871e

Hulme, Katrin, Little, Paul, Burrows, Abigail, Julia, Anna and Moss-Morris, Rona (2019) Subacute fatigue in primary care – two sides of the story. British Journal of Health Psychology, 1-24. (doi:10.1111/bjhp.12361).

Record type: Article

Abstract

Objectives: Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner (GP) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved. Design: A qualitative study design was used. In-depth, semi-structured telephone interviews were conducted with 14 patients and 14 GPs (non-dyadic), recruited from 19 primary care practices. Methods: Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives. Results: Three main themes were identified. Within these, subthemes from patients’, GPs’, or shared patient/GP perspectives emerged. The main themes encompassed the following: (1) Change from normal – the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GPs’ knowledge was often not reflected in patients’ accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated. Conclusions: Some findings, such as impact, mirror those described in chronic fatigue. New insights into early-stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re-presenting. These highlight the need for better communication and shared understanding. GPs should pre-emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests. Statement of contribution What is already known on this subject? Patients with chronic fatigue retrospectively report lack of understanding from GPs in early stage of illness. Little research has investigated the early stages of the fatigue trajectory. What does this study add? Consequences of an episode of subacute fatigue are similar to those reported for CFS. There is discordance between GPs’ positive view of negative tests and patients’ need for explanation of symptoms. The length of appointments is a significant barrier for creating shared understanding.

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Hulme et al 2019 British Journal of Health Psychology - Version of Record
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e-pub ahead of print date: 8 March 2019
Keywords: fatigue, primary care, qualitative

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Local EPrints ID: 429146
URI: http://eprints.soton.ac.uk/id/eprint/429146
ISSN: 1359-107X
PURE UUID: 09ee9df4-5f6e-46aa-aff3-c6a0fafcefc5

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Date deposited: 22 Mar 2019 17:30
Last modified: 07 Oct 2020 00:59

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Contributors

Author: Katrin Hulme
Author: Paul Little
Author: Abigail Burrows
Author: Anna Julia
Author: Rona Moss-Morris

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