LaKrista Morton1, Alison Elliott2, Jennifer Cleland3, Vincent Deary4, Christopher Burton5. 1. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: l.morton@abdn.ac.uk. 2. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: a.m.elliott@abdn.ac.uk. 3. Division of Medical and Dental Education, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: jen.cleland@abdn.ac.uk. 4. Department of Psychology, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK. Electronic address: vincent.deary@northumbria.ac.uk. 5. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK. Electronic address: c.burton@abdn.ac.uk.
Abstract
OBJECTIVE: To develop a taxonomy of explanations for patients with persistent physical symptoms. METHODS: We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained," physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. RESULTS: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts - generic statements about normal or dysfunctional processes; Causes - person-specific statements about proximal or distal causes for symptoms; Mechanisms - processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components. CONCLUSIONS: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency. PRACTICE IMPLICATIONS: The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.
OBJECTIVE: To develop a taxonomy of explanations for patients with persistent physical symptoms. METHODS: We analysed doctors' explanations from two studies of a moderately-intensive consultation intervention for patients with multiple, often "medically-unexplained," physical symptoms. We used a constant comparative method to develop a taxonomy which was then applied to all verbatim explanations. RESULTS: We analysed 138 explanations provided by five general practitioners to 38 patients. The taxonomy comprised explanation types and explanation components. Three explanation types described the overall structure of the explanations: Rational Adaptive, Automatic Adaptive, and Complex. These differed in terms of who or what was given agency within the explanation. Three explanation components described the content of the explanation: Facts - generic statements about normal or dysfunctional processes; Causes - person-specific statements about proximal or distal causes for symptoms; Mechanisms - processes by which symptoms arise or persist in the individual. Most explanations conformed to one type and contained several components. CONCLUSIONS: This novel taxonomy for classifying clinical explanations permits detailed classification of explanation types and content. Explanation types appear to carry different implications of agency. PRACTICE IMPLICATIONS: The taxonomy is suitable for examining explanations and developing prototype explanatory scripts in both training and research settings.
Authors: Joanna Leaviss; Sarah Davis; Shijie Ren; Jean Hamilton; Alison Scope; Andrew Booth; Anthea Sutton; Glenys Parry; Marta Buszewicz; Rona Moss-Morris; Peter White Journal: Health Technol Assess Date: 2020-09 Impact factor: 4.014
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