title: Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.
abstract: BACKGROUND
  Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.
  
  
  OBJECTIVE
  To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.
  
  
  METHODS
  Randomized, single-blind feasibility study.
  
  
  METHODS
  University-based geriatric and internal medicine primary care clinics.
  
  
  METHODS
  45 patients 66 years of age or older without a psychiatric diagnosis.
  
  
  METHODS
  Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).
  
  
  METHODS
  The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.
  
  
  RESULTS
  One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.
  
  
  CONCLUSIONS
  Findings support the feasibility of implementing the protocol as a primary care intervention.
authors.affiliation: University of Alabama at Birmingham, 330 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294-0022, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Klapow
authors.forename: S M
authors.initials: SM
authors.lastname: Schmidt
authors.forename: L A
authors.initials: LA
authors.lastname: Taylor
authors.forename: P
authors.initials: P
authors.lastname: Roller
authors.forename: Q
authors.initials: Q
authors.lastname: Li
authors.forename: J W
authors.initials: JW
authors.lastname: Calhoun
authors.forename: J
authors.initials: J
authors.lastname: Wallander
authors.forename: J
authors.initials: J
authors.lastname: Pennebaker
mesh_terms: D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D012106:Research; D012650:Self Disclosure; D016037:Single-Blind Method; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology*; D013315:Stress, Psychological / Q000628:therapy; D011795:Surveys and Questionnaires; D014956:Writing