title: Explaining fatigue: an examination of patient causal attributions and their (in)congruence with family doctors' initial causal attributions.
abstract: BACKGROUND
  General practitioners (GPs) and patients can have different ideas about the causes of fatigue, which may hinder management of fatigue.
  
  
  OBJECTIVE
  To investigate the causal attributions of patients and their GPs for fatigue, their level of agreement, and the association between patients' attributions, and fatigue characteristics and other illness perceptions.
  
  
  METHODS
  Baseline data, collected between 2004 and 2006, of a prospective cohort study among 642 adult patients presenting to Dutch primary care practices (n = 147) with a main symptom of fatigue, were used. Patient causal attributions and illness perceptions were measured using the revised illness perception questionnaire (fatigue version). GP causal attributions were measured with an open question included in the form that was completed at the end of the patient's visit. Fatigue severity was measured using the checklist individual strength.
  
  
  RESULTS
  Psychosocial causes were among the most often reported causal attributions by both patients and GPs. In 33% of 519 cases, the GP had no idea about the cause whereas the patient did. Overall, the agreement between the first reported causal attribution of patients and GPs was low. Qualitative differences in the labelling of causes were also found. Type of attribution (physical vs psychosocial/psychological) was associated with duration of fatigue (40 vs 25 months), and personal control (score 17.4 vs. 18.9).
  
  
  CONCLUSIONS
  Most patients and GPs had ideas about the causes of fatigue, but differences were found in the first reported causes and the labelling of causes. The findings may provide leads for optimizing communication about fatigue.
authors.affiliation: a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: Iris
authors.initials: I
authors.lastname: Nijrolder
authors.affiliation: b Department of Public Mental Health , Netherlands Institute of Mental Health and Addiction , Utrecht , the Netherlands.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Leone
authors.affiliation: a Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research , VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: Henriette E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D001291:Attitude of Health Personnel; D001519:Behavior; D003863:Depression / Q000523:psychology; D005221:Fatigue / Q000209:etiology*; D058006:General Practice; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007389:Internal-External Control; D008019:Life Style; D059352:Musculoskeletal Pain / Q000150:complications; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000523:psychology; D012216:Rheumatic Diseases / Q000150:complications; D020377:Self Efficacy; D057566:Self Report; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology
keywords: Anxiety; communication; depression; family medicine; general; general practice; sleep; somatization; surmenage