Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial

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Anne Weiland
Annette H Blankenstein
Jan L Van Saase
Henk T Van der Molen
David Kosak
René M Vernhout
Lidia R Arends


Objectives: Medically unexplained physical symptoms (MUPS) burden patients in their well-being and functioning and have a prevalence of approximately 25-50% in primary and specialist care. Medical specialists often find patients with unexplained symptoms difficult to deal with, whereas patients are not always understood. We report effects on patient outcomes of an evidence-based MUPS-focused communication training for medical specialists.Methods: In a multi-center randomized controlled trial medical specialists and residents allocated to the intervention received a 14-hour MUPS-focused communication training. They practiced a patient-centered approach, including multi-factorial symptom exploration and explanation of MUPS with perpetuating factors. To study intervention effects, each doctor had to include three MUPS patients before and three after the intervention and to ask them to complete questionnaires at baseline and at 3 and 6 months follow-up. The questionnaires included illness worries (Whitely Index), symptom severity (Visual Analogue Scale), distress, depression, anxiety and somatization (4DSQ) and daily functioning (SF-36).Results: A sufficient number of 123 medical specialists and residents participated in the study. They included 478 MUPS patients. Out  of them, 297 patients filled out questionnaires at baseline, 165 patients at 3-months follow-up and 71 patients at 6-months follow-up. Recruitment of patients was lower than expected and patients’ non-response to baseline and follow-up questionnaires was higher than estimated. No significant effects were found on patient outcomes.Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered. New research with special attention to patient recruitment and retention is needed to answer this question.

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Regular Articles
Author Biographies

Anne Weiland, Erasmus MC, University Medical Center Rotterdam, Netherlands; Erasmus University Rotterdam, Netherlands

Department of Internal Medicine, coordinator MUPS- research & training. MSc.Faculty of Social Sciences,Institute ofPsychology,researcher.

Annette H Blankenstein, VU UniversityMedicalCenterAmsterdam, TheNetherlands.

Department of General Practice and Elderly Care Medicine, Head of the Vocational Residents Programme for general practitioners. PhD MD.

Jan L Van Saase, Erasmus MC,UniversityMedicalCenter,Rotterdam, The Netherlands.

Department of Internal Medicine, Chair of the department. Prof. PhD. MD

Henk T Van der Molen, Erasmus University Rotterdam, The Netherlands.

Faculty of Social Sciences, Institute of Psychology; Dean, Prof. PhD.

David Kosak, ErasmusUniversityRotterdam, TheNetherlands

Institute of Health Policy & Management. MSc.

René M Vernhout, Erasmus MC,UniversityMedicalCenter,Rotterdam, TheNetherlands

Clinical Trial Centre, senior trialmanager, MSc

Lidia R Arends, Erasmus University Rotterdam, The Netherlands. ErasmusMC,UniversityMedicalCenter,Rotterdam, TheNetherlands.

Department of Biostatistics, biostatistician. Prof, PhD.Faculty of Social Sciences, Institute of Psychology and Pedagogical Sciences. Prof, PhD.


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