Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review... 2023 McGhie-Fraser et al

Highlights

• Systematic review of PSS stigma questionnaires among healthcare professionals.
• No single instrument provided acceptable evidence on all measurement properties.
• Content validity was inconsistent or indeterminate across all instruments.
• Involvement of professionals and patients is needed to establish content validity.

Abstract

Objective
Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use.

Methods
A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments.

Results
We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate.

Conclusion
No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399923000168

 

Great example of where medicine badly, so badly, needs the humanities.

If you ask racist people whether they are racist, most will think they aren't. Same with misogyny and any form of bigotry. By definition lacking empathy for a group of people means you can't understand how they are affected. And I emphasize here that I mean empathy, not sympathy, the ability to understand the other person's perspective, which in the case of everything psychosomatic is basically completely disastrous.

You could do similar experiments a century ago about women, to any room, because any such room would only be filled by men with very prejudicial and ignorant views about women as some sort of quasi-human but endearing pet. It was never a lack of technical understanding, or of science. It's an issue of humanity, of basic respect for a fellow human being who deserves to be treated the same way expect for themselves.

Asking the people responsible for the discrimination, and not the victims, is as valid as asking about racism in the American deep south, and only talking to police officers. Or asking someone "what did you forget?" Sure, they could figure out by working it, but by definition if one forgot something, they're not remembering it.

It's actually shocking how unable physicians are to understand the basics of this issue. They never get it, not until it happens to them. All they have to do is treat us the same way they expect to be treated, which they are clearly not, and that's most of the issue right there. Even the letter isn't respected, but the spirit has simply been shot twice in the back of the head and buried deep underground when it comes to us.

 

Weird language construction: "stigmatisation by healthcare professionals towards patients". Stigmatisation is a noun, the name for an outcome of the verb to stigmatise. If healthcare professionals hold a stigma about patients, then by definition it is the healthcare professionals who are creating the stigmatisation - there's no directionality either toward or away from - it has occurred.

First author also author of: "Quality assessment and stigmatising content of Wikipedia articles relating to functional disorders" discussion here: https://www.s4me.info/threads/funct...media-and-discussion.23802/page-8#post-460864