Influence of Watchful Waiting on Satisfaction and Anxiety Among Patients Seeking Care for Unexplained Complaints

Marloes A. van Bokhoven; Hèlen Koch; Trudy van der Weijden; Richard P. T. M. Grol; Arnold D. Kester; Paula E. L. M. Rinkens; Patrick J. E. Bindels; Geert-Jan Dinant

doi:10.1370/afm.958

Abstract

PURPOSE We undertook a study to determine whether test-ordering strategy and other consultation-related factors influence satisfaction with and anxiety after a consultation among patients seeking care for unexplained complaints.

METHODS A cluster-randomized clinical trial was conducted in family medicine practices in the Netherlands. Participants were 498 patients with unexplained complaints seen by 63 primary care physicians. Physicians either immediately ordered a blood test for patients or followed a 4-week watchful waiting approach. Physicians and patients completed questionnaires asking about their characteristics, satisfaction with care, and anxiety, and aspects of the consultation. The main outcomes were patient satisfaction and anxiety. Data were analyzed by multilevel logistic regression analysis.

RESULTS Patients were generally satisfied with their consultation and had moderately low anxiety afterward (mean scores on 11-point scales, 7.3 and 3.1, respectively), with no difference between the immediate testing and watchful waiting groups (χ² = 2.4 and 0.3, respectively). The factors associated with higher odds of satisfaction were mainly related to physician-patient communication: patients’ satisfaction with their physician generally, feeling taken seriously, and knowing the seriousness of complaints afterward; physicians’ discussing testing and not considering complaints bearable; and older physician age. The same was true for factors associated with higher odds of anxiety: patients expecting testing or referral, patients not knowing the seriousness of their complaints afterward, and physicians not seeing a cause for alarm.

CONCLUSIONS Test-ordering strategy does not influence patients’ satisfaction with and anxiety after a consultation. Instead, specific aspects of physician-patient communication are important. Apparently, primary care physicians underestimate how much they can contribute to the well-being of their patients by discussing their worries.

Footnotes

Conflicts of interest: none reported
Funding support: This study was funded by the Dutch College of Health Care Insurances (CVZ). Supplementary financial support was provided by the Centraal Ziekenfonds (CZ) health insurance company, the Netherlands Organization for Scientific Research (NWO), the “De Drie Lichten” foundation, the Foundation for Public Health and Smoking (STIVORO), and the Netherlands Heart Foundation. None of the agencies funding the study influenced the study design, the writing of the manuscript, or the decision to submit the manuscript for publication.
Trial Registry Number: ISRCTN55755886.
Results of this study were presented in part at the 26th European Conference on Psychosomatic Research, September 27–30, 2006, Cavtat, Dubrovnik, Croatia.