“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

Abstract

BackgroundMany 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.MethodsIn 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.ResultsPatients 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.ConclusionsPatients 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.

‘No need to worry’: an exploration of general practitioners’ reassuring strategies

“…The context-specific and goal-directed character of doctor-patient communication has also been shown in previous research [27,40,41]. The situation-specificity of reassurance has also been demonstrated in our study exploring the patients’ perspective on reassurance, which showed that what is experienced as reassuring by patients largely depends on their specific worrying cognitions [38]. …”

“…This is in line with Epstein et al who recommended that empathy should be expressed in the beginning of the consultation, as it facilitates biomedical inquiry, reassurance and action [15]. However, affective reassurance seems to directly reassure patients who worry about the impact of their complaints on their daily functioning and do not feel heard and taken seriously by others [38]. …”

Which patient and doctor behaviours make a medical consultation more effective from a patient point of view. Results from a European multicentre study in 31 countries

“…Future research should look for additional patient and contextual characteristics which might influence patient preferences. Examples of other potentially explicatory patient variables whose impact on communication has been checked by previous studies are personality traits (extra-introversion) [44], state and trait anxiety [45], trust [46], attachment style [47], and health literacy [10,48]. Contextual characteristics could include for instance the accessibility, continuity of care, coordination with other levels of health care and comprehensiveness, which describe the quality of healthcare systems [49,50].…”

Developmental study of treatment fidelity, safety and acceptability of a Symptoms Clinic intervention delivered by General Practitioners to patients with multiple medically unexplained symptoms

“…The SCI is based on the premise that patients with symptoms value the following: being listened to and understood; constructive explanations which make sense of their symptoms; and support in living with their symptoms [10][11][12]. It builds on the reattribution model [13] in three ways -by using more time (similar to other moderate intensity interventions [14]), by expanding the language of explanations for symptoms, specifically avoiding simple psychosomatic causal links [4,15,16], and by emphasising management of symptoms as problems in their own right with direct impacts on quality of life.…”