Discussion
FGID, chronic GI symptoms, chronic abdominal pain
DISEASE, SECONDARY
This qualitative interview study of the expectations and experiences when visiting a GP for chronic GI symptoms revealed three key themes: disease burden, GP–patient relationship and reassurance. The basis of our conceptual framework is that the disease burden and pre-existing GP–patient relationship influence expectations. When a GP met parental expectations, a trusting doctor–patient relationship ensued, creating an environment that allowed affective and cognitive reassurance. Within this framework, specific needs of parents influenced the themes and their interrelationships: for the GP to acknowledge the disease burden, to search for an explanation together with the GP and to feel reassured. GPs should be aware that when they recognise and respond to these needs, they can positively influence the consultation experience of parents.In this study, parents felt reassured through different pathways, with the success of a given reassurance strategy being situation specific. Sometimes a warm GP–patient relationship, instilling feelings of safety and comfort, was sufficient to provide reassurance (affective reassurance). Other times, parents needed cognitive reassurance, for example through an explanatory model for the symptoms. The need for an explanatory model is in concordance with a Norwegian study among parents of children with chronic abdominal pain.Our findings fit with the theory of contextualising care, which advocates for medical decisions to be based on both biomedical evidence and the individual patient’s context.The Dutch GP guideline advises that practitioners schedule a follow-up consultation for children with chronic abdominal pain.To the best of our knowledge, there is no other study in which parents and children were interviewed about their expectations and experiences of a GP consultation when the child has chronic GI symptoms. This is important because, in a gatekeeping system such as that in the Netherlands, the GP is the first physician to see a child with chronic GI symptoms and will typically manage most cases without referral to secondary care. Therefore, our results are transferable to other countries with gatekeeping systems, such as the UK and Canada.This study knows some limitations. Despite the intention to interview children, only 2 children aged ≥12 years participated. While their expectations and experiences fit within the conceptual framework, they differed from the parent perspective. More importantly, the small number of participating children does not allow us to draw conclusions about their expectations and experiences. This implies that our findings are only transferable to parental expectations and experiences. Future studies should explore children’s perspectives, evaluate the framework’s applicability to their expectations and experiences. Additionally, all participants had a typical Dutch cultural background. Almost a quarter of the Dutch population are first- or second generation immigrants, and each could have different expectations and experiences of healthcare that vary with their cultural beliefs.A strength of this study is that all respondents were asked to provide feedback on a synopsis of their interview (member check 1) and the three respondents who constituted the representative cases were asked to provide more detailed feedback about our interpretation of their stories (member check 2). Another strength is that two researchers with different backgrounds performed all the interviews and main analyses, while another five researchers (two GPs, a primary care researcher, epidemiologist and a medical sociologist) participated in the coding, thereby offering different theory perspectives.In conclusion, our findings suggest that an interrelationship exists between disease burden, the GP–patient relationship, and the reassurance given to parents and children who visit a GP for chronic GI symptoms. Although in our study the appropriate GP response was situation specific, planning a follow-up consultation is an important first step in addressing the needs of parents. We therefore recommend GPs to do accordingly, as it fosters an enduring GP–patient relationship, that is beneficial for all conditions, but particularly for patients with FSS. Further research should evaluate whether this framework also holds true for children and explore the views and experiences of GPs about these consultations. Finally, future studies should investigate whether using this framework in daily practice will help GPs manage children with FGID and other FSS clusters and improve the quality of consultation experiences for parents and children.