Barriers and facilitators to implementing interventions for [MUS] in primary and secondary care: A systematic review, 2021, Hanssen, Rosmalen et al

Full title: Barriers and facilitators to implementing interventions for medically unexplained symptoms in primary and secondary care: A systematic review

Abstract

Objective
To integrate existing literature on barriers and facilitators to implementing interventions for Medically Unexplained Symptoms (MUS) in primary and secondary care.

Method
Systematic review following PRISMA guidelines. A search of PsychINFO/Pubmed/Web of Science was performed to select studies focusing on MUS-interventions and implementation. All included papers were checked for quality and bias. A narrative synthesis approach was used to describe the included papers by implementation level, ranging from the specific intervention to the broader economic/political context.

Results
20 (quantitative/qualitative/mixed design) papers were included, but the quantitative studies especially, lacked methodological quality, with possible publication bias as a result. Results showed that the intervention needs to be acceptable and in line with daily practice routines. The professional's attitude and skills are important for implementation success, as well as for overcoming problems in the professional-patient interaction. If patients stick to finding a somatic cause, this hampers implementation. A lack of time is a frequently mentioned barrier at the organizational level. Barriers/facilitators at the social context level and at the economic/political level were barely reported on in the included papers.

Conclusion
Results were integrated into an existing implementation model, as an example of how MUS-interventions can be successfully implemented in practice.

Open access, https://www.sciencedirect.com/science/article/pii/S0163834321001444

 

Damn patients.

 

Barriers and facilitators to implementing interventions for medically unexplained symptoms in primary and secondary care: A systematic review .
they should not be making up interventions for anything ! when you do not understand the cause of a problem you have no chance of fixing it .

 

Well this clearly illustrates they are not talking about a descriptive category of medically unexplained symptoms, but a pseudo psychiatric diagnostic label of ‘Medically Unexplained Symptoms’.

Unfortunately MUS is not even a syndrome with clearly described symptoms, rather it is an expression of the personal beliefs of the diagnostician. Indeed the advocates of this pseudo diagnosis base it on totally circular logic by refusing clinical adequate assessment on the grounds that such would encourage false somatisation by patients. There are neither objective criterion for independent confirmation of inclusion and/or exclusion in this category nor any testable theoretical underpinning for their preferred psycho behavioural interventions.

 

The full-text states:

"Barriers- If patients (or their parents in case of children and adolescents) stick to finding a somatic cause for the symptoms, this hampers the implementation of MUS-interventions, both according to professionals and patients/parents themselves [14,15,26].

[...]

Facilitators- On the other hand, if patients believe that the intervention can help with dealing with MUS, and believe that it is acceptable to receive psychological treatment for MUS [10,26,44,46,47], this is helpful for the successful implementation of MUS-interventions.
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It also says that it helps if therapists believe the intervention is effective. That's called a "facilitator".

 

Apparently, this study received EU funding.

"This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 733025"​

 

This is a rather strange statement if you think of it.

The symptoms are medically unexplained. So that means that we don't know if they have a somatic cause or not. In some cases, it might not while in other cases there will likely be a somatic cause. So the belief of patients will sometimes be correct.

If this correct belief hampers the implementation of an intervention, that says something about that intervention and the prejudices it employs.

This seems to be the main team of the MUS literature: they keep using the wording "medically unexplained" but from everything they say they seem to imply "psychosomatic".

 

Honest people need to believe the lie to retell it convincingly. Not all therapists are dishonest, so...