Family Practice Advance Access originally published online on November 14, 2008
Family Practice 2009 26(1):40-47; doi:10.1093/fampra/cmn087
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Patients' explanatory models for irritable bowel syndrome: symptoms and treatment more important than explaining aetiology
a School of Medicine and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees TS17 6BH, UK
b Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
c Department of Anthropology, Durham University, 43 Old Elvet, Durham DH1 3HN, UK
Correspondence to A P S Hungin, School of Medicine and Health, Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees TS17 6BH, UK; Email: a.p.s.hungin{at}durham.ac.uk
Received 11 May 2008; Revised 8 October 2008; Accepted 26 October 2008.
 |
Abstract |
|---|
Background. Irritable bowel syndrome (IBS) is a common condition associated with no certain organic cause, though diet and stress are widely implicated. The condition is frustrating for both sufferers and doctors, and there are problems in diagnosing and treating the condition. Eliciting explanatory models (EMs) is a useful tool for understanding how individuals relate to their illnesses and their expectations for treatment, particularly for illnesses with uncertain aetiology like IBS.
Objectives. To understand the EMs, experiences and expectations for management of patients with IBS.
Methods. Qualitative, semi-structured interviews were conducted with 51 primary care patients (31 in the UK, 20 in The Netherlands) meeting the Rome II diagnostic criteria for IBS.
Results. Although IBS often had a significant dampening effect on daily life, IBS patients made great efforts not to allow the condition to take over their lives. Triggers of symptoms were more important to patients than understanding the underlying aetiology of IBS. Diet and stress were both recognized as important triggers, but views about which foods were problematic and the extent to which stress was modifiable were inconsistent. Diagnosis and treatment were often a confusing and frustrating process, and patients often expected more diagnostic tests than they were offered before receiving a diagnosis of IBS. However, the often poor outcome of medical interventions does not, in general, appear to have a negative impact on the patient–doctor relationship.
Conclusions. Clinicians should be aware of the extensive impact of IBS on sufferers’ daily life and the frustration that results from repeatedly trying treatments with little effect. Clearly explaining the guidelines for diagnosing IBS and the range of treatment options may help patients to make sense of the diagnostic and treatment processes. The personal EM should be addressed during the consultation with the IBS patient, ensuring that any successive medical interventions match with the patients’ disease perception.
Keywords. Explanatory model, irritable bowel syndrome, patient perception, primary care, qualitative.
Casiday RE, Hungin APS, Cornford CS, de Wit NJ and Blell MT. Patients' explanatory models for irritable bowel syndrome: symptoms and treatment more important than explaining aetiology. Family Practice 2009; 26: 40–47.