PhD Studentship: Developing models of safe effective reassurance

Reassurance is a key component of clinical encounters and comprises both short term and long-term components. Short term reassurance (“relief”) comes from clinical authority or negative test results. Long term reassurance (“assurance”) requires a cognitive shift in order to re-interpret ongoing symptoms as non-threatening, while knowing what constitutes an appropriate threshold for further concern. Most clinical encounters provide only short-term reassurance. Furthermore, sustained reassurance may be undermined by routinely used safety-netting explanations (such as “if it doesn’t settle call back”). The consequence of less effective reassurance is increased use of, and reliance on, healthcare.

This PhD will address reassurance in clinical encounters in three stages. The first will involve observing consultations (ethnography) and interviewing patients. The student and supervisors will jointly identify specific clinical areas for that: it is likely that one will involve symptoms with a threat of persistence and progression (e.g. MSK) and one involve symptoms with a threat of serious disease or consequences (e.g. ENT). The second stage will involve identifying and developing possible explanatory “scripts” for use in consultations through literature review, discussion with clinicians, and with insights obtained from observations of consultations. The third stage will involve testing of video vignettes of consultations including different explanatory scripts with patients.

All three components will enable the student to develop skills in the collection and analysis of qualitative data. The PhD will be jointly based in ScHARR and the Academic Unit of Primary Medical Care in order that the student benefits both from the critical mass of health services research skill within ScHARR and the clinical context of AUPMC.

The supervisors both have expertise in this area. Professor Burton is a GP and international expert on clinical explanation; he led a systematic review which showed that negative diagnostic tests (when there is a low pre-test probability of disease) do not produce sustained reassurance. Dr Sanders is a social scientist whose work focuses on clinical communication and knowledge mobilisation / implementation of health-related research. Professor Burton is chief investigator and Dr Sanders a co-investigator on a large NIHR-funded trial to improve management of persistent physical symptom which will begin in 2018.

This PhD will enable the student to develop expertise in conducting qualitative health services research and developing complex interventions for use in front-line healthcare. It fits into a broader programme of work aimed at helping clinical professionals to deliver safe and effective reassurance to patients.

Funding Notes

The Faculty Scholarships for Medicine, Dentistry & Health cover fees and stipend at Home/EU level. Overseas students may apply but will need to fund the fee differential between Home and Overseas rate from another source.