Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

Cape, John; Geyer, Connie; Barker, Chris; Pistrang, Nancy; Buszewicz, Marta; Dowrick, Christopher; Salmon, Peter

doi:10.3399/bjgp10x532567

Cited by 26 publications

(30 citation statements)

References 21 publications

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“…General practitioners (GPs) and practice nurses (PNs) were interviewed, with consent, usually within two weeks after the recorded consultation and these interviews used the method of tape-assisted recall (TAR) [22]. TAR is an established method that has been used both in primary [22] and secondary care settings [23,24]. Playing back sections of the recording facilitated respondent recall and helped to anchor their reflections in specific consultations.…”

Section: Methodsmentioning

confidence: 99%

How QOF is shaping primary care review consultations: a longitudinal qualitative study

et al. 2013

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BackgroundLong-term conditions (LTCs) are increasingly important determinants of quality of life and healthcare costs in populations worldwide. The Chronic Care Model and the NHS and Social Care Long Term Conditions Model highlight the use of consultations where patients are invited to attend a consultation with a primary care clinician (practice nurse or GP) to complete a review of the management of the LTC. We report a qualitative study in which we focus on the ways in which QOF (Quality and Outcomes Framework) shapes routine review consultations, and highlight the tensions exposed between patient-centred consulting and QOF-informed LTC management.MethodsA longitudinal qualitative study. We audio-recorded consultations of primary care practitioners with patients with LTCs. We then interviewed both patients and practitioners using tape-assisted recall. Patient participants were followed for three months during which the research team made weekly contact and invited them to complete weekly logs about their health service use. A second interview at three months was conducted with patients. Analysis of the data sets used an integrative framework approach.ResultsPractitioners view consultations as a means of ‘surveillance’ of patients. Patients present themselves, often passively, to the practitioner for scrutiny, but leave the consultation with unmet biomedical, informational and emotional needs. Patients perceived review consultations as insignificant and irrelevant to the daily management of their LTC and future healthcare needs. Two deviant cases, where the requirements of the ‘review’ were subsumed to meet the patient’s needs, focused on cancer and bereavement.ConclusionsRoutine review consultations in primary care focus on the biomedical agenda set by QOF where the practitioner is the expert, and the patient agenda unheard. Review consultations shape patients’ expectations of future care and socialize patients into becoming passive subjects of ‘surveillance’. Patient needs outside the narrow protocol of the review are made invisible by the process of review except in extreme cases such as anticipating death and bereavement. We suggest how these constraints might be overcome.

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Section: Methodsmentioning

confidence: 99%

How QOF is shaping primary care review consultations: a longitudinal qualitative study

et al. 2013

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“…The result may be less guideline-concordant care, but enhanced patient-led decision making. 41 Implications for research and practice Future research on doctor-patient conversations about depression is needed to test the results of this exploratory study. Research should be conducted in the future to confirm the influence of problem narratives on physician decision making about depression found in the present study.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes

et al. 2012

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“…It is also important to recognize the experiences and motivation that patients bring to the interaction . Patients' own resources can be overshadowed by rigidity in the therapeutic approach, and it is important to maximize patients' sense of control within the relationship, as this tends to be fragile for those with mental health difficulties .…”

Section: Discussionmentioning

confidence: 99%

“…33 It is also important to recognize the experiences and motivation that patients bring to the interaction. 45,46 Patients' own resources can be overshadowed by rigidity in the therapeutic approach, 47 and it is important to maximize patients' sense of control within the relationship, as this tends to be fragile for those with mental health difficulties. 44,48 The facilitative practitioner may harness patients' positive efforts and at the same time ease their distress by encouraging greater, potentially restorative, self-kindness.…”

Section: Enabling Progress Of Patient Resourcesmentioning

confidence: 99%

‘She believed in me’. What patients with depression value in their relationship with practitioners. A secondary analysis of multiple qualitative data sets

Percival

Donovan

Keßler

et al. 2016

Health Expectations

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BackgroundClinical guidance promotes the practitioner–patient relationship as integral to good quality person‐centred care for patients with depression. However, patients can struggle to engage with practitioners and practitioners have indicated that they want more guidance on how to establish effective relationships with their patients.ObjectiveTo identify what practitioner attributes patients with depression particularly value or find problematic.MethodA secondary analysis of data collected during four qualitative studies, all of which entailed interviewing patients diagnosed with depression about their treatment experiences. Patients in the four studies had received different treatments. These included antidepressants, cognitive behaviour therapy, facilitated physical activity and listening visits. We thematically analysed 32 patient accounts.ResultsWe identified two complimentary sets of important practitioner attributes: the first based on the practitioner's bearing; the second based on the practitioner's enabling role. We found that patients value practitioners who consider their individual manner, share relevant personal information, show interest and acceptance, communicate clearly and listen carefully, collaborate on manageable goals and sanction greater patient self‐care and self‐compassion. It was also evident that patients receiving different treatments value the same practitioner attributes and that when these key practitioner qualities were not evident, patients were liable not to re‐attend or comply with treatment.ConclusionThe practitioner attributes that patients with depression most value have a positive impact on their engagement with treatment. Patients emphasise the importance of a practitioner's demeanour and encouragement, rather than the amount of time or specific treatment a practitioner is able to provide.

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Facilitating understanding of mental health problems in GP consultations: a qualitative study using taped-assisted recall

Cited by 26 publications

References 21 publications

How QOF is shaping primary care review consultations: a longitudinal qualitative study

How QOF is shaping primary care review consultations: a longitudinal qualitative study

What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes

‘She believed in me’. What patients with depression value in their relationship with practitioners. A secondary analysis of multiple qualitative data sets

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