Patients' perspectives on improvement of medically unexplained physical symptoms: a qualitative analysis

Abstract

Title: Patients’ perspectives on improvement of Medically Unexplained Physical Symptoms: a qualitative analysis. Background: Medically unexplained physical symptoms (MUPS) are common. Knowledge of Knowledge on factors contributing to improvement of MUPS may be useful for the development of more effective treatments. This study aims to assess the factors contributing to improvement of symptoms, according to recently improved MUPS patients. Methods: This qualitative study is part of a prospective cohort study on the course of MUPS. We selected patients with at least moderate MUPS at baseline and with a substantial decrease of symptoms after 6 or 12 months. We performed semi-structured interviews. Recordings were transcribed verbatim and analysed in ATLAS.ti. Findings: Although saturation of data was reached after 6 interviews, 9 patients were interviewed. Their symptoms had developed gradually and worsened until a certain point of crisis. Before this crisis patients were focused on finding symptom causes and on becoming one’s old self again. The experience of a crisis made them accept their situation. This resulted in a search for improvement instead of recovery. Participants started taking control of their own well-being by coping differently (e.g. by pacing activities and relaxing effectively), mostly supported by a therapist. This led to symptom improvement. Participants deemed it important that General Practitioners and therapists were coaching and took their problem seriously. Received therapies varied from regular therapies to complementary therapies. The latter were experienced as effective, as they combined psychological and physical components. Some participants missed this multidimensional approach in regular treatments. Conclusions: Acceptance of symptoms and their consequences seems to be the most important condition for improvement of MUPS. As a moment of personal crisis forms the most important motivation for acceptance, it may be something that cannot be forced by therapists. Nevertheless, General Practitioners and therapists can support patients on their way to acceptance. A wish for multidimensional treatments in regular health care was identified.