Chronic fatigue syndromes: real illnesses that people can recover from.

The 'Oslo Chronic Fatigue Consortium' consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

Evaluating a training intervention for improving alignment between emergency medical telephone operators and callers: a pilot study of communication behaviours.

BACKGROUND: Calls to emergency medical lines are an essential component in the chain of survival. Operators make critical decisions based on information they elicit from callers. Although smooth cooperation is necessary, the field lacks evidence-based guidelines for how to achieve it while adhering to strict parameters of index-driven questioning. We aimed to evaluate the effect of a training intervention for emergency medical operators at a call centre in Tønsberg, Norway. The course was designed to enhance operators' communication skills for smoothing cooperation with callers. METHODS: Calls were analyzed using inductively developed coding based on the course rationale and content. To evaluate whether the course generated consolidated behavioral change in everyday practice, the independent analyst evaluated 32 calls, selected randomly from eight operators, two calls before and two after course completion. To measure whether skill attainment delayed decision making, we compared the time to the first decision logged by intervention operators to eight control operators. Analysis included 3034 calls: 1375 to intervention operators (T1 = 815; T2 = 560) and 1659 to control operators (T1 = 683; T2 = 976). RESULTS: Operators demonstrated improved behaviours on how they greeted the caller (p < .001), acknowledged the caller (p < .001), and displayed empathy (p = 0.015). No change was found in the use of open-ended questions and agreeing with the caller. Contrary to expectations, operators who took the course logged first decisions more quickly than the control group (p < .001). CONCLUSIONS: This pilot study demonstrated that the training intervention generated behavioural change in these operators, providing justification for scaling up the intervention.

Long-term effect of communication training on the relationship between physicians' self-efficacy and performance.

OBJECTIVE: To examine the long term impact of a communication skills intervention on physicians' communication self-efficacy and the relationship between reported self-efficacy and actual performance. METHODS: 62 hospital physicians were exposed to a 20-h communication skills course according to the Four Habits patient-centered approach in a crossover randomized trial. Encounters with real patients before and after the intervention (mean 154 days) were videotaped, for evaluation of performance using the four habits coding scheme. Participants completed a questionnaire about communication skills self-efficacy before the course, immediately after the course, and at 3 years follow-up. Change in self-efficacy and the correlations between performance and self-efficacy at baseline and follow-up were assessed. RESULTS: Communication skills self-efficacy was not correlated to performance at baseline (r=-0.16; p=0.22). The association changed significantly (p=0.01) and was positive at follow-up (r=0.336, p=0.042). The self-efficacy increased significantly (effect size d=0.27). High performance after the course and low self-efficacy before the course were associated with larger increase in communication skills self-efficacy. CONCLUSION: A communication skills course led to improved communication skills self-efficacy more than 3 years later, and introduced a positive association between communication skills self-efficacy and performance not present at baseline. PRACTICE IMPLICATIONS: Communication skills training enhances physicians' insight in own performance.

Specialist physicians' sensitivity to patient affect and satisfaction.

BACKGROUND: Studies indicate that physicians do not respond adequately to patients' emotional issues. Physician sensitivity to patient affect has not been much explored. OBJECTIVES: To describe specialist physicians' sensitivity to patient affect and satisfaction. RESEARCH DESIGN: Cross-sectional study of physicians' and patients' postvisit questionnaire statements about patient affective states and satisfaction. SUBJECTS: A representative sample of 71 physicians covering nonpsychiatric clinical specialties in a general teaching hospital were observed during 497 encounters with patients (outpatient, inpatient on rounds, emergency room, maximum 8 encounters per physician). MEASURES: Standardized correlations between physician and patient statements. RESULTS: Physician statements about patient negative affect were moderately correlated with patient self-report of negative affect [r=0.379 (0.301; 0.452)]. Physician statements about patient positive affect and patient satisfaction were weakly correlated with patient self-report of positive affect [r=0.238 (0.153; 0.319)] and satisfaction [r=0.219 (0.134; 0.301)]. Internists [r=0.300 (0.161; 0.428)] were significantly less sensitive to negative affect than surgeons [r=0.500 (0.360; 0.618), P=0.038] and neurologists [r=0.621 (0.432; 0.758), P=0.007]. Physicians previously known by the patient were significantly more sensitive to negative affect than those who were not known [r=0.509 (0.391; 0.611) vs. 0.293 (0.189; 0.390), P=0.006]. We could not find differences in affective sensitivity between male and female physicians. CONCLUSIONS: Specialist physicians have moderate ability to identify patient negative affect and poor ability to identify patient positive affect and patient satisfaction.

Physicians' responses to patients' expressions of negative emotions in hospital consultations: a video-based observational study.

OBJECTIVE: Patients express their negative emotions in medical consultations either implicitly as cue to an underlying unpleasant emotion or explicitly as a clear, unambiguous concern. The health provider's response to such cues and concerns is important for the outcome of consultations. Yet, physicians often neglect patient's negative emotions. Most studies of this subject are from primary health care. We aimed to describe how physicians in a hospital respond to negative emotions in an outpatient setting. METHODS: Ninety six consultations were videotaped in a general teaching hospital. The Verona Coding Definitions of Emotional Sequences was used to identify patients' expression of negative emotions in terms of cue and concern and to code physicians' subsequent responses. Cohen's kappa was used as interrater reliability measure. Acceptable kappa level was set to .60. RESULTS: We observed 163 expressions of negative emotions. In general, the physician responses to patients' cues and concerns did not include follow up or exploration. Concerns more often than cues led to lack of emotional exploration. CONCLUSIONS: When patients expressed negative emotions or cues to such, hospital physicians tended to move away from emotional communication, particularly if the emotion was expressed as an explicit concern. PRACTICE IMPLICATIONS: Medical training should enable physicians' to explore the patients' emotions in situations where it will improve the medical treatment.

Patients' negative emotional cues and concerns in hospital consultations: a video-based observational study.

OBJECTIVE: Little is known about the frequency and occurrence of patients' negative emotional cues and concerns (NECC) across specialties in hospital departments. METHODS: Ninety-six consultations were videotaped in a general hospital. The VR-CoDES (Verona Coding Definitions of Emotional Sequences) were used to code the patients' NECC. Cohen's kappa was used to establish reliability between coders. RESULTS: Cohen's kappa was above 0.60. NECC were observed in more than half of the consultations. The number of NECC in the consultations was 163, with 109 negative emotional cues and 54 concerns. The mean number of NECC in the consultations was 1.69, with a median of 1. The first NECC in consultations were stated after a median duration of 5min 21s. We could not find significant differences related to the gender and age of the patient or the physician, or the specialty of the physician. CONCLUSIONS: More than half of the concerns were not preceded by a negative emotional cue. Few consultations contained more than 3 NECC, and NECC tended to be expressed relatively early. PRACTICE IMPLICATIONS: Patients' expressions of emotional issues are few, and most of them are subtle. Physicians should be thoroughly trained to identify and respond to them.

Post-recruitment confirmation of informed consent by SMS.

BACKGROUND: To allow patients to reflect about a decision to participate in a clinical trial, guidelines suggest a 24-h delay from when they are informed about the trial to when they give consent. In certain clinical settings, this is likely to hamper recruitment. METHOD: After oral and written information about the trial has been given in person, the patient signs the declaration of consent knowing that they will be asked again after 24 h whether they confirm or regret the decision. This procedure can be done by SMS. The investigators must document the response. The procedure was tried in a study in which the doctors were randomly assigned to receive a clinical communication skills course, and encounters with patients were videotaped before and after the course. RESULTS: 553 patients were approached, 530 (95.8%) gave initial consent, eight of these later regretted their consent. DISCUSSION: The low level of regrets suggests this is an acceptable procedure for patients. TRIAL REGISTRATION: The RCT was registered before initiation - registration # ISRCTN22153332.

[Self-efficacy among doctors in hospitals after a course in clinical communication]. / Endring i mestringstillit hos sykehusleger etter kurs i klinisk kommunikasjon.

BACKGROUND: There is a paucity of research on clinical communication in hospitals. A large Norwegian hospital has tried out a course (developed in the USA) in clinical communication. In this substudy, we investigated the association between doctors' self-efficacy and participation in this course. MATERIAL AND METHODS: Doctors under 60 years of age, working in clinical somatic departments in Akershus University Hospital, were eligible for inclusion. The participants completed a validated questionnaire before and after the course. Self-efficacy was assessed (on a 10-point scale) through nine important communication skills. RESULTS: 103 doctors (randomly selected) were asked to participate in the study; 62 of them completed the 20-hour course. After completion of the course, the participants were more confident that communication skills could be learnt in this way than they were before it started. Their self-efficacy only improved moderately, on average 0.6 on the 10-point scale, but the change was statistically significant for seven of the nine skills. After completion of the course, self-efficacy had improved for 41 doctors and deteriorated for ten. Nevertheless, the latter were still positive regarding the learning effect of the course. The effects were independent of the doctors' sex, age, position (resident or consultant), self-efficacy before the course, and specialty. Of the skills taught, demonstration of empathy was the one that fewest doctors wanted to practice after the course. INTERPRETATION: A short course in clinical communication skills led to a moderate improvement in the participating doctors' self-efficacy. Whether this change implies improved communication is currently under investigation.