Barriers and facilitators to GP–patient communication about emotional concerns in UK primary care: a systematic review

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Abstract

Background

In the UK, general practitioners (GPs) are the most commonly used providers of care for emotional concerns.

Objective

To update and synthesize literature on barriers and facilitators to GP–patient communication about emotional concerns in UK primary care.

Design

Systematic review and qualitative synthesis.

Method

We conducted a systematic search on MEDLINE (OvidSP), PsycInfo and EMBASE, supplemented by citation chasing. Eligible papers focused on how GPs and adult patients in the UK communicated about emotional concerns. Results were synthesized using thematic analysis.

Results

Across 30 studies involving 342 GPs and 720 patients, four themes relating to barriers were: (i) emotional concerns are difficult to disclose; (ii) tension between understanding emotional concerns as a medical condition or arising from social stressors; (iii) unspoken assumptions about agency resulting in too little or too much involvement in decisions and (iv) providing limited care driven by little time. Three facilitative themes were: (v) a human connection improves identification of emotional concerns and is therapeutic; (vi) exploring, explaining and negotiating a shared understanding or guiding patients towards new understandings and (vii) upfront information provision and involvement manages expectations about recovery and improves engagement in treatment.

Conclusion

The findings suggest that treatment guidelines should acknowledge: the therapeutic value of a positive GP–patient relationship; that diagnosis is a two-way negotiated process rather than an activity strictly in the doctor’s domain of expertise; and the value of exploring and shaping new understandings about patients’ emotional concerns and their management.

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Most cited references 44

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Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials.

Simon Griffin, Ann-Louise Kinmonth, Marijcke Veltman … (2004)

We wanted to identify published randomized trials of interventions to alter the interaction between patients and practitioners, develop taxonomies of the interventions and outcomes, and assess the evidence that such interventions improve patients' health and well-being. Undertaking a systematic review of randomized trials, we sought trials in primary and secondary care with health-related outcomes, which we found by searching MEDLINE, HealthSTAR, and PsycINFO bibliographic databases through 1999. We also completed one round of manual citation searching. Thirty-five trials were included. Most were set in primary care in North America. Trials were heterogeneous in populations, settings, interventions, and measures. Interventions frequently combined several poorly described elements. Explicit theoretical underpinning was rare, and only one study linked intervention through process to outcome measures. Health outcomes were rarely measured objectively (6 of 35), and only 4 trials with health outcomes met predefined quality criteria. Interventions frequently altered the process of interactions (significantly in 73%, 22 of 30 trials). Principal outcomes favored the intervention group in 74% of trials (26 of 35), reaching statistical significance in 14 (40%). Positive effects on health outcomes achieved statistical significance in 44% of trials (11 of 25); negative effects were uncommon (5 of 25, 20%). Simple approaches to increasing the participation of patients in the clinical encounter, such as providing practitioners with a note from patients about their concerns beforehand, showed promise, as did more complex programs providing specific information about disease and attention to emotion. Apparently similar interventions varied in effectiveness across studies. Successful interactions between patients and their practitioners lie at the heart of medicine, yet there are few rigorous trials of well-specified interventions to inform best practice. Trial evidence suggests that a range of approaches can achieve changes in this interaction, and some show promise in improving patients' health. To advance knowledge further, we need to replicate promising studies using rigorous methods. These should include explicit theoretical frameworks designed to link effects on key communication and interaction characteristics through to effects on health outcomes.

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The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review

Laura Thompson, Rose McCabe (2012)

Background Nonadherence to mental health treatment incurs clinical and economic burdens. The clinician-patient alliance, negotiated through clinical interaction, presents a critical intervention point. Recent medical reviews of communication and adherence behaviour exclude studies with psychiatric samples. The following examines the impact of clinician-patient alliance and communication on adherence in mental health, identifying the specific mechanisms that mobilise patient engagement. Methods In December 2010, a systematic search was conducted in Pubmed, PsychInfo, Web of Science, Cochrane Library, Embase and Cinahl and yielded 6672 titles. A secondary hand search was performed in relevant journals, grey literature and reference. Results 23 studies met the inclusion criteria for the review. The methodological quality overall was moderate. 17 studies reported positive associations with adherence, only four of which employed intervention designs. 10 studies examined the association between clinician-patient alliance and adherence. Subjective ratings of clinical communication styles and messages were assessed in 12 studies. 1 study examined the association between objectively rated communication and adherence. Meta-analysis was not possible due to heterogeneity of methods. Findings were presented as a narrative synthesis. Conclusions Clinician-patient alliance and communication are associated with more favourable patient adherence. Further research of observer rated communication would better facilitate the application of findings in clinical practice. Establishing agreement on the tasks of treatment, utilising collaborative styles of communication and discussion of treatment specifics may be important for clinicians in promoting cooperation with regimens. These findings align with those in health communication. However, the benefits of shared decision making for adherence in mental health are less conclusive than in general medicine.

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Stigma about depression and its impact on help-seeking intentions.

Robert Barney, Anthony F. Jorm, Jeffrey K Griffiths … (2005)

Research has shown that people are reluctant to seek professional help for depression, especially from mental health professionals. This may be because of the impact of stigma which can involve people's own responses to depression and help-seeking (self stigma) as well as their perceptions of others' negative responses (perceived stigma). The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression. A total of 1,312 adults randomly sampled from the Australian community completed a questionnaire providing a depression vignette and measures of self- and perceived-stigmatizing responses, source-specific help-seeking intentions, current depressive symptoms and depression experience, and demographics. Many people reported they would feel embarrassed about seeking help from professionals, and believed that other people would have a negative reaction to them if they sought such help. Some expected professionals to respond negatively to them. Responses varied according to the sources of professional help. Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources. Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help. Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking, and should target younger people.

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Author and article information

Journal

Journal ID (nlm-ta): Fam Pract

Journal ID (iso-abbrev): Fam Pract

Journal ID (publisher-id): famprj

Title: Family Practice

Publisher: Oxford University Press (UK )

ISSN (Print): 0263-2136

ISSN (Electronic): 1460-2229

Publication date Collection: 01 August 2020

Publication date (Electronic): 22 January 2020

Publication date PMC-release: 22 January 2020

Volume: 37

Issue: 4

Pages: 434-444

Affiliations

[1 ] Institute of Health Research, College of Medicine and Health, University of Exeter , UK

[2 ] Faculty of Medicine and Dentistry, Plymouth University, Plymouth, UK

[3 ] School of Health Sciences, Division of Health Services Research and Management, City, University of London , London, UK

Author notes

Correspondence to Daisy Parker, University of Exeter College of Medicine and Health, 1.07 College House, University of Exeter St Luke’s Campus, Heavitree Road, Exeter EX1 2DJ, UK; E-mail: d.e.parker@ 123456exeter.ac.uk

Article

Publisher ID: cmaa002

DOI: 10.1093/fampra/cmaa002

PMC ID: 7474532

PubMed ID: 31967300

SO-VID: b67233f3-3466-404e-89a5-6b06e8d4cc5a

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Page count

Pages: 11

Funding

Funded by: Judi Meadows Memorial;

Funded by: McPin Foundation;

Funded by: University of Exeter Medical School;

Funded by: National Institute for Health Research, DOI 10.13039/501100000272;

Funded by: Collaboration for Leadership in Applied Health Research and Care South West Peninsula;