Conceptual framework reflecting expectations, experiences and needs of parents and of children visiting their general practitioner with chronic gastrointestinal symptoms

Sophie Ansems, Ilse Ganzevoort, Donald Van Tol, Tryntsje Fokkema, Marijke Olthof, Marjolein Berger, Gea Holtman

Background:
Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are therefore key components of the physician’s management. Qualitative studies have shown how parents experience specialist pediatric care, yet less is known about GPs, who manage most cases in the Netherlands.

Research questions:
What are the expectations and experiences of parents and children when visiting a GP for chronic gastrointestinal symptoms?

Method:
We conducted a qualitative interview study in The Netherlands. We purposively sampled participants from a randomized controlled trial evaluating the effectiveness of fecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Online interviews were audio and video recorded, transcribed verbatim and independently analyzed by the first 2 authors. Data were collected and analyzed concurrently until data saturation was reached. Using thematic content analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework.

Results:
Thirteen parents and 2 children (15 and 17 years old) participated. Three key themes emerged: disease burden, GP–patient relationship, and cognitive reassurance. Often, the experienced disease burden and the pre-existing GP–patient relationship influenced expectations (e.g., for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP–patient relationship ensued that facilitated cognitive reassurance. We found that individual needs influenced these themes and their interrelationships, and when recognized and met by the GP, improved the quality of the consultation experience.

Conclusions:
Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for both parents and children. Further research should evaluate whether this is the case.

Points for discussion:
Do these results sufficiently reflect the child perspective or do we need further exploration?

Can our results be generalized to other functional somatic symptoms in children (such as chronic fatigue or headaches)?

How could this framework help GPs in managing children with chronic gastrointestinal symptoms?