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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Researcher Tim C. olde Hartman, Radboud University Medical Center, The Netherlands
- Second opponent: Head Physician Helena Liira, Helsinki University Hospital, Finland
- Third member and chair of the evaluation committee: Professor Anne Kveim Lie, University of Oslo
Chair of the Defence
Professor emeritus Magne Nylenna, University of Oslo
Principal Supervisor
Professor Erik Lønnmark Werner, Universitetet i Oslo
Summary
Medically unexplained physical symptoms (MUPS) refer to patients suffering from persistent, distressing symptoms over several months. These symptoms may lead to significant functional impairment, negatively impacting quality of life, healthcare costs, and work participation. The symptoms often cannot be explained by medical examinations, and patients frequently receive negative test results. Biological and psychosocial factors usually underlie these symptoms. Patients with MUPS are common in general practice and often feel misunderstood and stigmatized.
General practitioners (GPs) frequently experience frustration and inadequacy due to the lack of precise diagnoses and treatment options. I developed a structured communication tool, the Individual Challenge Inventory Tool (ICIT), to assist GPs in explaining symptoms, administering treatments to alleviate these symptoms and improve daily functioning, and evaluating the necessity of sick leave as part of the treatment when needed.
Firstly, we conducted a focus group study to assess the acceptability of implementing the ICIT in primary care. Secondly, we evaluated the effects of ICIT on patients' health and sickness absence from work. Finally, we sought to identify any objective patient characteristics that might influence the effectiveness of the GPs' use of ICIT.
In Paper I, we utilized semi-structured focus group interviews. In Paper II, we employed a clusterrandomized controlled trial, while in Paper III, regression analyses were conducted on the participant group treated with ICIT. In Study 1, eight GPs participated in the focus group, which was analyzed using systematic text condensation. Study 2 involved 103 GPs who were organized into 10 groups and randomized at the group level. 541 patients were recruited for the cRCT, with data analyzed using multilevel analyses. In Study 3, regression analyses were performed on 223 participants in the intervention group to identify predictors, with all predictors measured at baseline.
In the focus group study, the GPs reported that ICIT facilitated the organization, clarification, and concretization of patient issues. They experienced a sense of mastery in providing treatment, discovered new aspects of their patients, and felt less fatigued. In the cRCT , 76% of patients in the intervention group reported improved function, symptoms, and quality of life, compared to 38% in the control group. After 11 weeks, the intervention group showed a 27-percentage point reduction in sick leave, compared to 4 percentage point in the control group.
In the predictor study, few factors could predict the effectiveness of the ICIT tool. Participants treated with ICIT who lived alone showed improved function, reduced symptoms, and enhanced quality of life four times more often than others. They also experienced a reduction in sick leave three times more frequently—those receiving long-term benefits experienced improvements twice as often as those not receiving such benefits.
The ICIT can enhance GPs' ability to manage challenging patient groups and improve primary care follow-up. Using ICIT by GPs improved patient function, symptoms, quality of life, work-related self-efficacy, and reduced sick leave. Since few factors could predict the effectiveness of the ICIT tool, this suggests it may apply to a broad range of patients with persistent physical symptoms. GPs might consider using ICIT for all primary care patients with ineffective coping strategies, particularly those who live alone.
Additional information
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