Incongruent Views of Quality of Life between Patients and Physicians: A Mixed-Methods Enquiry
[eng] Functional gastrointestinal disorders (FGIDs) continue to be the most common disorders treated in gastroenterological practice. They are associated with higher levels of psychological distress, impaired quality of life and increased healthcare use. The main objective of the current thesis was...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2021 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/184041 |
| Acceso en línea: | https://hdl.handle.net/2445/184041 http://hdl.handle.net/10803/673738 |
| Access Level: | acceso abierto |
| Palabra clave: | Malalties del tracte gastrointestinal Atenció primària Relacions metge-pacient Diagnòstic Satisfacció dels pacients Gastrointestinal system diseases Primary care Physician-patient relationships Diagnosis Patient satisfaction |
| Sumario: | [eng] Functional gastrointestinal disorders (FGIDs) continue to be the most common disorders treated in gastroenterological practice. They are associated with higher levels of psychological distress, impaired quality of life and increased healthcare use. The main objective of the current thesis was to evaluate the level of discrepancy (i.e., incongruence) between patients and physicians quality of life, as well as the effect this has on psychological distress, physician satisfaction and quality of life. More specifically, we explored the effect of incongruence in a primary care setting and compared this between two patient groups: patients with an FGID diagnosis and patients with an organic diagnosis. In order to pursue our main objective, two studies were carried out. The first study involved a systematic review examining the potential benefits of short-term educational interventions. The second study was a cross sectional mixed-methods study that aimed to explore the differences that exist between incongruent and diagnostic groups in relation to psychological distress, physician satisfaction and quality of life. This also involved assessing the aforementioned variables whilst taking into account other variables that could potentially be moderating the relationship. The final part of the study involved implementing a qualitative approach which consisted of focus groups with patients and semi-structured interviews with physicians. The results from the first study indicated that short educational programmes could benefit both patients and physicians, yet there still appears to be limited research regarding effective programmes that specifically target symptom severity and quality of life of patients. Furthermore, training and intervention opportunities for physicians are still relatively sparse leading to difficulties when assisting patients in practice. The findings from the analyses conducted with incongruence as a dichotomised variable showed that both incongruence and diagnosis contribute to psychological distress. Patients in the incongruent group had higher scores on psychological distress than congruent patients. On the other hand, no significant differences were found between incongruent and congruent patients in relation to physician satisfaction levels. Patients with an FGID diagnosis had higher scores on psychological distress and lower physician satisfaction levels than patients with an organic diagnosis. The results from the analyses carried out with incongruence as a continuous variable supported this further. Statistically significant positive correlations were found for incongruence with psychological distress and age. Female patients and patients with an FGID diagnosis had higher levels of psychological distress and worse quality of life, as well as lower physician satisfaction in the case of patients with an FGID diagnosis. A statistically significant positive correlation was found only for physician satisfaction and age. When carrying out multiple regression models, we found that gender and incongruence had the greatest influence on psychological distress. Finally, from the moderation models we found that only age was a significant moderator between incongruence and psychological distress. From the qualitative part of the research, five major themes were found when conducting a thematic analysis: (1) Illness, Emotional and Personal Problems (2) Disease- Healthcare System Interaction (3) Health system (4) Intervention and (5) Patients. From the patient focus groups key factors were outlined as needing to be addressed such as the overload of the healthcare system and long waiting lists. From the physician interviews we identified that a lack of resources and a clear referral pathway to mental health services may be contributing to the difficulties when treating these patients. To our knowledge, this is the first study to investigate the influence of incongruence in primary healthcare settings using this procedure. Additionally, as far as we are aware this is also the first study to explore the underlying reasons for incongruence using a qualitative approach. |
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