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Cognitive and affective reassurance and patient outcomes in primary care: A systematic review

Pincus, Tamara,*; Holt, Nicolaa; Vogel, Stevenb; Underwood, Martinc; Savage, Richardd; Walsh, David Andrewe; Taylor, Stephanie Jane Carolinef

doi: 10.1016/j.pain.2013.07.019
Article

Summary Cognitive reassurance (explanation, education) is associated with improved outcomes in patients in primary care. Affective reassurance (rapport, empathy) is related only to patients’ satisfaction.

In the context of uncertainty about aetiology and prognosis, good clinical practice commonly recommends both affective (creating rapport, showing empathy) and cognitive reassurance (providing explanations and education) to increase self-management in groups with nonspecific pain conditions. The specific impact of each of these components in reference to patients’ outcomes has not been studied. This review aimed to systematically evaluate the evidence from prospective cohorts in primary care that measured patient–practitioner interactions with reference to patient outcomes. We carried out a systematic literature search and appraisal of study methodology. We extracted measures of affective and cognitive reassurance in consultations and their associations with consultation exit and follow-up measures of patients’ outcomes. We identified 16 studies from 16,059 abstracts. Eight studies were judged to be high in methodological quality. Pooling could not be achieved as a result of heterogeneity of samples and measures. Affective reassurance showed inconsistent findings with consultation exit outcomes. In 3 high-methodology studies, an association was found between affective reassurance and higher symptom burden and less improvement at follow-up. Cognitive reassurance was associated with higher satisfaction and enablement and reduced concerns directly after the consultations in 8 studies; with improvement in symptoms at follow-up in 7 studies; and with reduced health care utilization in 3 studies. Despite limitations, there is support for the notion that cognitive reassurance is more beneficial than affective reassurance. We present a tentative model based on these findings and propose priorities for future research.

aDepartment of Psychology, Royal Holloway University of London, Egham, UK

bResearch Centre, British School of Osteopathy, London, UK

cDivision of Health Sciences, Warwick Medical School, Coventry, UK

dStockwell Group Practice, London, UK

eArthritis Research UK Pain Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK

fQueen Mary University of London, Barts and The London School of Medicine, London, UK

*Corresponding author. Address: Royal Holloway, University of London, Egham Hill, Egham, Surrey TW20 0EX, UK. Tel.: +44 1784443523; fax: +44 1784434347.

E-mail: t.pincus@rhul.ac.uk

Submitted April 12, 2013; revised July 12, 2013; accepted July 15, 2013.

© 2013 Lippincott Williams & Wilkins, Inc.
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