Presentation T P3

T P3 (Poster Presentation):
Why are general practitioners reluctant to enrol patients into a randomized controlled trial on sick leave? A qualitative study

Presented by: Silje Maeland

Authors

Maeland S1,2, Magnussen LH2,3, Eriksen HR1,4, Malterud K1,3,5

  1. Uni Health, Uni Research, Bergen
  2. Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen
  3. Department of Global Public Health and Primary Care, University of Bergen, Bergen
  4. Hemil, Research Centre for Health Promotion, University of Bergen, Bergen
  5. Research Unit for General Practice, Uni Health, Uni Research, Bergen, Norway

Abstract

Background

Sick leave assessments are often challenging and complex, and trust in the patients knowledge of self is crucial. It is commonly accepted that being out of work can be detrimental for health and well-being. Low levels of medically certified sick leave among employees reporting poor health, predict subsequent improvement in health status, but the directions of associations may be debated. There is still scarce knowledge regarding the health effects of sick leave, indicating that this is an intervention, which deserves scientific exploration. To assess the effects of sick leave in patients with common, subjective health complaints, a RCT was planned. Patients for whom the GP was uncertain if sick leave was the right treatment for recovery, would be randomized to sick leave (2-4 weeks) or not (0-5 days). In spite of serious efforts, we failed to recruit enough GPs to participate in such a study. This paper does not deal with the originally intended RCT. The experiences from unsuccessful recruitment to the RCT was the background for this study to find out more about why GPs are reluctant to enrol patients into a randomized controlled trial on sick leave.

Methods

Qualitative data presenting individual arguments for refusal were obtained from 50 Norwegian GPs as written answers to a web-based, open-ended questionnaire in 2009. They share their arguments in free text based on the following question: ”Describe concrete challenges you will meet if sick listing of your patients should be decided by randomization in a research project”. The data were analysed with systematic text condensation.

Results

First, the complexity of clinical judgment was addressed. Would it be ethically acceptable to set the professional and medical assessment aside, and if so, was there any better judge than the regular GP in making this important decision? Second, the arguments dealing with sick leave as a human and legal right were addressed. Will patients feel they have a legitimate right to sick leave and will they be open for discussion with their GP? Third, the risk of jeopardizing the relationship between patient and doctor was emphasized. Would the patients be able to trust their GP if he or she offered the patient entry into a trial where sick leave would be decided by randomization?

Conclusions

Randomization of sick leave in general practice in Norway was not viewed as feasible by the GPs themselves because of the importance of clinical judgment, ethical obligations, belief that the patients would refuse participation, and thereby disturbing the doctor-patient relationship.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Social issues