The association between patients' expectations and experiences of task-, affect- and therapy-oriented communication and their anxiety in medically unexplained symptoms consultations

Abstract

Background: It is unknown whether patients with medically unexplained symptoms (MUS) differ from patients with medically explained symptoms (MES) regarding their expectations and experiences on task-oriented communication (ie, communication in which the primary focus is on exchanging medical content), affect-oriented communication (ie, communication in which the primary focus is on the emotional aspects of the interaction) and therapy-oriented communication (ie, communication in which the primary focus is on therapeutic aspects) of the consultation and the extent to which GPs meet their expectations.

Objective: This study aims to explore (a) differences in patients' expectations and experiences in consultations with MUS patients and patients with MES and (b) the influence of patients' experiences in these consultations on their post-visit anxiety level.

Study design: Prospective cohort.

Setting: Eleven Dutch general practices.

Measurements: Patients completed the QUOTE-COMM (Quality Of communication Through the patients' Eyes) questionnaire before and after the consultation to assess their expectations and experiences and these were related to changes in patients' state anxiety (abbreviated State-Trait Anxiety Inventory; STAI).

Results: Expectations did not differ between patients with MUS and MES. Patients presenting with either MUS or MES rated their experiences for task-related and affect-oriented communication of their GP higher than their expectations. GPs met patients' expectations less often on task-oriented communication in MUS patients compared to MES patients (70.2% vs 80.9%; P = ˂0.001). Affect-oriented communication seems to be most important in reducing the anxiety level of MUS patients (β -0.63, 95% Cl = -1.07 to -0.19).

Discussion: Although the expectations of MUS patients are less often met compared to those of MES patients, GPs often communicate according to patients' expectations. Experiencing affect-oriented communication is associated with a stronger reduction in anxiety in patients with MUS than in those with MES.

Conclusion: GPs communicate according to patients' expectations. However, GPs met patients' expectations on task-oriented communication less often in patients with MUS compared to patients with MES. Experiencing affect-oriented communication had a stronger association with the post-consultation anxiety for patients with MUS than MES.

Keywords: anxiety; consultation; doctor-patient communication; expectations; general practice; medically unexplained symptoms.