Abstract
Background:
A distinction has been posited between cognitive (informational) and affective (emotional) reassurance, with a suggestion that affective reassurance may negatively affect patient outcomes by reducing patients' motivation to engage with information conducive to recovery. Cognitive reassurance, though, provides explanations and information to help patients self-manage, and so aids recovery. However, research is lacking on how each actually affects patient outcomes in primary care.
Purpose of the Study:
To develop a valid measure of practitioner reassurance, and assess the impact of different reassurance strategies on patients' outcomes.
Methods:
A 30-item questionnaire was developed and piloted. This questionnaire was sent to patients who had recently consulted their GP for low back pain, along with measures of satisfaction and enablement. After 3 months, participants returned questionnaires assessing psychological and pain-related outcomes. The questionnaire was validated using Rasch modelling, and the effects of reassurance on outcomes were assessed using hierarchical linear regressions.
Results:
The questionnaire was reduced to 12-items, consisting of 4 3-item subscales which were shown to be valid and reliable. Practitioners' cognitive reassurance was associated with lower pain intensity 3-months post-consultation, whereas affective reassurance showed the opposite effect. Use of affective reassurance alone of the 4 reassurance subscales failed to predict patient satisfaction. Affective reassurance showed positive association with enablement, but negatively predicted further healthcare utilisation at 3-months.
Conclusion:
There is some evidence that cognitive reassurance is more beneficial to patients than affective reassurance, which can lead to worse pain and increased healthcare utilisation.
