Patient and primary care practitioners’ perspectives on consultations for fibromyalgia: a qualitative evidence synthesis

Abstract

Background: Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled. Methods: CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed. Results: In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down – exploring the chaos experienced by patients as they seek help; (2) negative cycle – highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle – validating patient–doctor relationships underpinned by clear communication can help break the negative cycle. Conclusions: Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient–doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.

The Fibromyalgia Decomposition Phenomenon: A Reflexive Thematic Analysis

“…There is a need for more timely diagnosis in FM patients [2,44], albeit with a recognition that a diagnosis alone is insufficient to capture what is important to patients [24]. The Faculty of Pain Medicine acknowledges the complexity of new patient consultations, recommending that new patient consultations should take one hour [70], recognising the need to assess the medical, psychological, and social influences on the experience of pain, and to consider the patient's individualised needs and perspectives [71].…”

“…The treatment experience of individuals usually involves multiple attempts at reducing pain by seeking an array of varying treatments. Medications account for a substantial proportion of medical costs [7], yet treatment-related satisfaction is poor [23][24][25][26] and high-quality evidence lacking-as described in the most recent European Alliance of Associations for Rheumatology (EULAR) international guidelines [27]. This is, in part, a contributory factor towards high medical costs-patients express low satisfaction towards treatments and continue to seek alternatives, an ineffective use of healthcare resources [7].…”

“…There is a further multitude of studies examining two or more FM "variables": sleep and FM [35], cognition and FM [36], mental health and FM [37], and fatigue and FM [38]. The most recent qualitative work identifies inter-relationships between the complex physical, psychological, and social needs of FM patients and the need to further explore explanatory models [39]; the immense disruption to lives of those with FM and the inadequacy of many treatments [23]; the need to recognise comorbid FM [40]; the need for professionals to understand preferences and to receive tailored guidance towards physical activity from professionals with adequate knowledge [14,41]; FM-associated fatigue as "unpredictable", "uncontrollable", "unseen", and "unintelligible" [42]; peer social support networks having positive biopsychosocial effects and empowering women to better manage their disease [43]; and the presence of a negative cycle relating to the quality and satisfaction of primary care consultations for FM, from both patient and clinician perspectives [24]. Furthermore, a recent large United Kingdom national study incorporating qualitative thematic analysis highlighted FM patients to be treated as a "low priority", with a sizable mismatch between the needs of these patients and National Healthcare Service (NHS) provisions, most notably, multidisciplinary holistic care and communitybased access to self-management.…”

Physiotherapists’ adherence to Clinical Practice Guidelines in fibromyalgia: a cross-sectional online survey

“…Education, understood as providing information about the disease and certainty about the prognosis, is considered the core of the treatment [ 12 ]. Patients usually express that better self-understanding their condition would lead to greater well-being [ 13 ], and that, conversely, the experience of invalidation and the inability to receive answers may have a negative impact on health-related outcomes as anxiety and/or depression [ 14 ]. Moreover, psychological therapies as behavioral-cognitive therapy or mindfulness-based stress reduction programs could be used as a part of multicomponent treatment, whether in cases of poor levels of initial improvement, or in patients with mood disorders (e.g.…”

Management perspectives from patients with fibromyalgia experiences with the healthcare pathway: a qualitative study

“…In a qualitative study, 76% of interviewed general practitioners found fibromyalgia time-consuming and frustrating (25). The patientdoctor relationship can then become a detrimental circle (26). The aim of this study is to perform a qualitative analysis of their doctor-patient relationship, through a first-person approach to look for new management methods for fibromyalgia tailored to the patient's experience.…”