Cognitive and affective reassurance and patient outcomes in primary care: a systematic review
Cognitive and affective reassurance and patient outcomes in primary care: a systematic review
In the context of uncertainty about aetiology and prognosis, good clinical practice commonly recommends both affective (creating rapport, showing empathy) and cognitive reassurance (providing explanations and education) to increase self-management in groups with non-specific pain conditions. The specific impact of each of these components in reference to patients' outcomes has not been studied. This review aimed to systematically evaluate the evidence from prospective cohorts in primary care that measured patient-practitioner interactions with reference to patient outcomes. We carried out a systematic literature search and appraisal of study methodology. We extracted measures of affective and cognitive reassurance in consultations and their associations with consultation-exit and follow up measures of patients' outcomes. We identified 16 studies from 16,059 abstracts. Eight studies were judged to be high in methodological quality. Pooling could not be achieved due to heterogeneity of samples and measures. Affective reassurance showed inconsistent findings with consultation exit outcomes. In three high-methodology studies, an association was found between affective reassurance and higher symptom burden and less improvement at follow up. Cognitive reassurance was associated with higher satisfaction and enablement and reduced concerns directly after the consultations in eight studies; with improvement in symptoms at follow up in seven studies; and with reduced health care utilization in three studies. Despite limitations, there is support for the notion that cognitive reassurance is more beneficial than affective reassurance. We present a tentative model based on these findings and propose priorities for future research.
2407-2416,
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Holt, Nicola
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Vogel, Steven
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Underwood, Martin
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Savage, Richard
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Walsh, David Andrew
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Taylor, Stephanie Jane Caroline
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1 November 2013
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Holt, Nicola
22e8be11-6d9d-4b00-b0c4-7c5207f30e25
Vogel, Steven
a9e25ead-dcfd-40ae-9756-b3c68c7252fc
Underwood, Martin
239a8609-e7b5-4acb-aaf9-9e7f717f0d62
Savage, Richard
70321c68-1240-4647-a052-a108fdc02feb
Walsh, David Andrew
a18c4d07-df3f-467f-a9cf-12bc3c7c495a
Taylor, Stephanie Jane Caroline
29f162d7-e404-47c6-8d73-20d7074848c4
Pincus, Tamar, Holt, Nicola, Vogel, Steven, Underwood, Martin, Savage, Richard, Walsh, David Andrew and Taylor, Stephanie Jane Caroline
(2013)
Cognitive and affective reassurance and patient outcomes in primary care: a systematic review.
Pain, 154 (11), .
(doi:10.1016/j.pain.2013.07.019).
Abstract
In the context of uncertainty about aetiology and prognosis, good clinical practice commonly recommends both affective (creating rapport, showing empathy) and cognitive reassurance (providing explanations and education) to increase self-management in groups with non-specific pain conditions. The specific impact of each of these components in reference to patients' outcomes has not been studied. This review aimed to systematically evaluate the evidence from prospective cohorts in primary care that measured patient-practitioner interactions with reference to patient outcomes. We carried out a systematic literature search and appraisal of study methodology. We extracted measures of affective and cognitive reassurance in consultations and their associations with consultation-exit and follow up measures of patients' outcomes. We identified 16 studies from 16,059 abstracts. Eight studies were judged to be high in methodological quality. Pooling could not be achieved due to heterogeneity of samples and measures. Affective reassurance showed inconsistent findings with consultation exit outcomes. In three high-methodology studies, an association was found between affective reassurance and higher symptom burden and less improvement at follow up. Cognitive reassurance was associated with higher satisfaction and enablement and reduced concerns directly after the consultations in eight studies; with improvement in symptoms at follow up in seven studies; and with reduced health care utilization in three studies. Despite limitations, there is support for the notion that cognitive reassurance is more beneficial than affective reassurance. We present a tentative model based on these findings and propose priorities for future research.
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Accepted/In Press date: 15 July 2013
Published date: 1 November 2013
Additional Information:
Copyright © 2013. Published by Elsevier B.V.
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Local EPrints ID: 469153
URI: http://eprints.soton.ac.uk/id/eprint/469153
ISSN: 0304-3959
PURE UUID: 4fe648cc-4a11-42c7-8476-690e90095285
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Date deposited: 07 Sep 2022 17:44
Last modified: 17 Mar 2024 04:11
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Contributors
Author:
Tamar Pincus
Author:
Nicola Holt
Author:
Steven Vogel
Author:
Martin Underwood
Author:
Richard Savage
Author:
David Andrew Walsh
Author:
Stephanie Jane Caroline Taylor
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