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This is a conversation analytic study of existing recorded GP-patient consultations. Conversation analysis (CA) is a micro-analytic approach which considers how speakers use both spoken language and non-verbal behaviour. This can include asking questions, providing explanations, or making evaluations. This study aims to analyse clinical consultations regarding PPS in a natural setting. The approach used is recordings of participants' visits to the GP who are experiencing PPS. The consultations are studied using conversation analysis, which is a well-established way of analysing in vivo communication and language used in a qualitative way. By understanding the linguistic characteristics and communication during medical consultations regarding PPS, this study aims to lay the groundwork for understanding the communication process regarding PPS and medically complex issues in primary care. The aim is to target the current gaps of knowledge in research regarding medical consultations of FDs and PPS. Further studies are planned to develop interventions in order to reduce stigma during medical consultations and increase the patient-clinican’s therapeutic alliance.

Functional Disorders (FD) are a group of disorders characterized by the presence of persistent physical symptoms that cannot be explained or attributed to any known or “well-defined” physical or psychiatric condition (1). It is a broad term that includes many disorders such as Fibromyalgia, Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome (IBS), Whiplash Associated Disorders (2-4). Fibromyalgia is characterised by chronic widespread pain associated with unrefreshing sleep and cognitive difficulties (5). Receiving a diagnosis for any FD usually depends on the symptoms displayed by patients as well as the treating physicians identifying these symptoms. However, many patients who meet the criteria for a diagnosis do not receive a formal diagnosis (6). Diagnostic labels allow healthcare professionals to assume the homogeneity of all members of a group given that label (7). They also create a space for patients with the same label to exist and have a sense of comradery and belonging (8). On the other hand, diagnostic labels may carry negative impacts for patients who receive them. For instance, a study comparing the impact of having a fatigue syndrome label found that patients with specific fatigue labels face worse prognosis than other patients in the same patient group (9). Another negative impact associated with diagnostic labels has been recognized in the field of psychiatry and neurology, where studies have shown that having a label of the disease is associated with patient experiences of stigma (10-12). Studying the effects of having a diagnostic label of FD is an important topic that remains relatively unexplored. This qualitative study aims to gather information from patient experiences on the impacts of receiving a diagnostic label of Fibromyalgia.

The study aims to understand the experiences of people with Fibromyalgia in healthcare consultations. In this study, we want to understand more about how people with chronic pain and Fibromyalgia experience stigma when they receive healthcare. We are looking at people’s experiences in health care consultations where they have felt stigmatised. By stigma we mean “being excluded, rejected, blamed, or devalued because you have a particular health problem’’. We know from PAE’s previous survey that this is a common experience of people with fibromyalgia. In this research we want to understand more about how stigmatising happens and how it can be prevented. We will use this understanding in later studies to design and test ways of teaching doctors and other professionals to be less stigmatising. This research comprises two linked studies using qualitative methods. Both will use iterative data collection and analysis. The study of diagnostic labels will use individual interviews and thematic analysis. The study of stigma will use focus groups and reflexive thematic analysis. Analysis of both studies will use a mixture of inductive (derived from the data) and deductive (applying existing theoretical models) approaches. Individuals and groups of participants from countries within Europe recruited through chronic pain patient advocacy and support groups affiliated to Pain Alliance Europe (PAE).

This study protocol describes a participatory study design for exploring and optimising the role of online educational resources for functional symptoms. We outline the processes which will be set up to support collaboration and co-creation with multiple stakeholders, including partners with lived experience of functional symptoms, and international healthcare colleagues. This project will result in an open access online educational resource, which can be validated for use by members of the public, patients and their care professionals.

A research project by the University of Sheffield in partnership with the University Medical Centre Groningen and Pain Alliance Europe. The study aims to understand the experiences of people with Fibromyalgia in healthcare consultations. We are aiming to learn more about the experiences of patients with and without a formal diagnosis of Fibromyalgia. This includes exploring the topics of quality of life, social interactions and interactions with healthcare professionals. We are also looking at people’s experiences in health care consultations where they have felt stigmatised. By stigma we mean “being excluded, rejected, blamed, or devalued because you have a particular health problem’’. We know from PAE’s previous survey that this is a common experience of people with fibromyalgia. In this research, we want to understand more about how stigmatising happens and how it can be prevented.

This mixed methodology study aims to describe how patient education about functional disorders differs across specialist treatment settings in Europe. We will first identify relevant network of treatment services providing specialist management of functional disorders across at least 6 European Countries, and systematically gather and analyse patient educational material that is currently in use across these services. The second stage will be to survey health-care professionals working within these services about their personal understanding of the aetiology of functional disorders, and their clinical practices with regard to patient education and guided self-help. In the third stage we will carry out in depth semi-structured interviews with a sample group of healthcare professionals to enable richer descriptions to be gathered. Qualitative data will be analysed using theoretically driven thematic analysis. This work will build on in-depth recent literature reviews of themes in etiological explanations, explanatory models and effective behavioural change techniques. Quantitative survey data will be organised to allow comparison between factors of interest in the data-set (these include the country, professional background of the participant, and clinical focus of the treatment service’). This study builds on the work of the Clinic of functional disorders at Aarhus University Hospital. The purpose of the study is to describe information that may be important in developing an e-health educational programme that has international usability and acceptability.

Background: The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer (PCa) randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective: To determine report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, Setting, and Participants: This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention: Two cohorts included 1643 men who agreed to be randomised; 997 declined randomisation and chose treatment. Outcome Measurements and Statistical Analysis: Health-related quality of life impacts on urinary, bowel, and sexual function were assessed using patient-reported outcome measures. Analysis was carried out based on treatment received for each cohort and on pooled estimates using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and Limitations: According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and outdating of the interventions being evaluated during the lengthy follow-up required in trials of screen-detected PCa. Conclusions: Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient Summary: More than 90 out of every 100 men with localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are much better after active monitoring, but the risks of spreading of prostate cancer are more common.