Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms.
BACKGROUND
Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.


OBJECTIVE
To determine if practice-based training of GPs in reattribution changes doctor-patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.


METHODS
Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.


RESULTS
With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference -0.9, 95% CI -1.6 to -0.1; P=0.027) with no other effects on patient outcome or health contacts.


CONCLUSIONS
Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.
Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7 2UH, UK. richard.morriss@nottingham.ac.uk
Richard
R
Morriss
Christopher
C
Dowrick
Peter
P
Salmon
Sarah
S
Peters
Graham
G
Dunn
Anne
A
Rogers
Barry
B
Lewis
Huw
H
Charles-Jones
Judith
J
Hogg
Rebecca
R
Clifford
Christine
C
Rigby
Linda
L
Gask
D016000:Cluster Analysis; D003142:Communication; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D010817:Physician-Patient Relations; D018794:Problem-Based Learning / Q000379:methods; D015397:Program Evaluation; D015203:Reproducibility of Results; D013001:Somatoform Disorders / Q000628:therapy*; D000078329:Workforce