Abstract
BackgroundThe NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition.MethodsA meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum.ResultsTwenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care.ConclusionsIn order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.
Highlights
The National Institute for Health and Clinical Excellence (NICE) guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs
Comparison with previous literature In line with the findings of a review completed by Elliot [39] in the 1990s, our analysis suggests that the reluctance to diagnose and manage CFS/ME is based on scepticism and a lack of knowledge about the condition [7,23, 26,31,40,41]
In order to reduce bias, four researchers who were not authors of any of the original studies were involved in the reviewing, data extraction and analysis stages. This meta synthesis shows that some GPs have overcome the multiple barriers to the diagnosis and management of CFS/ME by building a positive, collaborative relationship with the patient, taking time to explain the rationale for treatment and validating the patients’ illness experience
Summary
The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME) is characterised by disabling, unexplained fatigue that is not alleviated by rest and lasts at least four months [1]. The UK National Institute for Health and Clinical Excellence (NICE) guideline, published in 2007 for CFS/ ME, emphasises the importance of an early diagnosis [1]. In a recent treatment trial, primary care patients reported waiting, on average, 3.7 years from onset of symptoms to diagnosis [10]. NICE guidance recommends that patients with CFS/ME receive early treatment with the use of tailored care-packages [1]. 65% of members of a UK patient organisation, Action for ME, reported never receiving any treatment [11]
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