Byrne, Ailish Katherine, Scantlebury, Arabella, Jones, Katherine, Doherty, Laura and Torgerson, David J. (2022) Communication interventions for medically unexplained symptom conditions in general practice : a systematic review and meta-analysis of randomised controlled trials. PLoS One, 17 (11). e0277538. doi:10.1371/journal.pone.0277538 ISSN 1932-6203.

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Abstract

Background
Medically unexplained symptoms (MUS) account for 3–50% of all General Practitioner (GP) consultations and are difficult to diagnose due to their unknown aetiology, symptom overlap between conditions, and lack of effective treatment options. MUS patients’ and primary care clinicians frequently face challenges during consultations, with GPs reporting difficulty identifying and classifying MUS, whilst patients report stigma and feeling illegitimised by clinicians. Communication interventions have been proposed as a method to facilitate the doctor-patient relationship and aid the management of MUS.

Aim
This systematic review aims to evaluate the effectiveness of primary care based communication interventions at improving MUS patients’ and/or clinician outcomes.

Method
Four electronic databases were searched from inception to November 2021. Two researchers independently undertook screening, data extraction and quality appraisal. Given the heterogeneous nature of the studies identified, narrative syntheses were conducted, along with meta-analyses where possible to pool data.

Results
9 papers from 10 Randomised Controlled Trials were included. The included studies displayed considerable risk of bias and poor reporting. Some limited evidence suggests that communication interventions tailored to MUS and not following a pre-specified model (such as reattribution) could improve pain, mental and physical functioning whilst reattribution training may improve clinician confidence treating MUS. However, methodological limitations mean that these findings should be interpreted with caution.

Conclusion
A range of interventions for improving communication with MUS patients in primary care have been evaluated. However, the heterogeneous nature of existing evidence and poor study quality mean we cannot conclude whether these interventions are effective. Before considering further randomised controlled trials researchers should focus on developing a new or modified communication intervention for MUS patients and their clinicians.

Trail registration
The systematic review was prospectively registered with PROSPERO (registration record CRD42020206437).

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Medicine, Psychosomatic, Somatoform disorders, Mind and body, Primary care (Medicine), Physician and patient
Journal or Publication Title:	PLoS One
Publisher:	Public Library of Science
ISSN:	1932-6203
Official Date:	14 November 2022
Dates:	Date Event 14 November 2022 Published 31 October 2022 Accepted
Volume:	17
Number:	11
Number of Pages:	19
Article Number:	e0277538
DOI:	10.1371/journal.pone.0277538
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	15 November 2022
Date of first compliant Open Access:	15 November 2022

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