Abstract General Practitioners (GPs) have been identified as 'gatekeepers' to existing psychological support services by Psychologists working in the field of appearance (Rumsey and Harcourt 2005, pg 146). Currently no research exists which investigates primary care decision making regarding referral of patients with disfigurements to psychological services. Therefore, this study utilised a mixed methods design and sought to investigate the factors which GPs, GP trainees and medical students use as cues in decision making regarding referral of patients with disfigurements to psychological services. Seventeen UK based GPs, eight GP Trainees and 25 medical students responded to 12 vignettes about hypothetical patients with disfigurements where variables regarding the severity and visibility of the patients' condition and their levels of psychosocial distress were systematically varied. Participants were asked to identify the patients' prevailing problems and rate their likelihood of referral to a range of services on a rating scale and provide qualitative responses on working with patients with disfigurements. Medics were most likely to refer patients experiencing high levels of distress to primary and secondary psychology services. GPs, trainees and medical students were also able to identify psychological distress and offered biopsychosocial explanations and consequences for the prevailing issues of the patients' detailed in the vignettes. Thematic analysis of qualitative data suggested an acknowledgement of patient need for psychosocial support but also barriers to provision within the National Health Service. However, participants' responses also revealed a reliance on cues to referral shown to be unrelated to psychological distress in previous studies. Medics accounted for the severity and visibility of a patients' condition in their decision making, particularly in the absence of high levels of distress, where severe and visible conditions were more likely to prompt referral than less visible or less severe conditions. This may be accounted for the lack of knowledge, experience and training reported by participants. Further research in this area is needed, not only to ensure that patients receive appropriate access to psychosocial support, but that health care professionals are adequately trained and supported in their medical decision making with patients with disfiguring conditions.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:572884 |
| Date | January 2012 |
| Creators | Jenkinson, Elizabeth Diane |
| Publisher | University of the West of England, Bristol |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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