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Table 1 Overview of the included studies

From: Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies

Study ID

Population (N)

Country setting

Primary objectives

Methods, recruitment and analysis

Appraisal of quality and relevance

Asbring and Narvanen [19]

26 health professionals

Sweden

Explore physicians’ perspectives on CFS and fibromyalgia patients, specifically their thoughts about these patient groups and what strategies they use in consultations with them.

Methods: Semi-structured interviews

Relevant: 2-2-1

Recruitment: CFS/fibromyalgia patients contacted and asked to identify physicians (patients identified through a previous study)

Analysis: Grounded theory principles (including constant comparison and thematic saturation but not theory development)

Ax et al. [20]

18 (9 patients each in 2 studies)

UK (England)

Explore CFS sufferers’ accounts of patient-professional communication, patient illness beliefs and treatment expectations, and consequences of interactions regarding treatment choice.

Methods: Semi-structured interviews

Relevant: 2-1-1

Recruitment: ME support group invitation

Analysis: Content analysis

Banks and Prior [21]

114 consultations observed with patients and health professionals.

UK (Wales)

Investigate lay and professional ideas about the nature of CFS, in

Methods: Patient-professional observations in an out-patients clinic, and structured interviews with patients.

Relevant: 2-2-1

particular, the ways in which understandings of the disorder are developed in a clinical setting.

Recruitment: CFS clinic (no further details)

Analysis: No clear description. Authors took a functional approach and analysed accounts of illness rather than beliefs about illness.

Bayliss et al. [22]

35 (11 patients, 2 carers, 9 GPs, 5 practice nurses, 4 CFS/ME

UK (England)

Explore BME patient, health professional and community leader’s views on the barriers to the diagnosis and management of CFS/ME in the BME population.

Methods: Semi-structured interviews

Key: 2-2-2

specialists and 5 BME community leaders)

Recruitment: Invited by letter/phone.

Analysis: Thematic analysis

Chew-Graham et al. [7]

38 (24 patients; 14 physicians)

UK (England)

Explore how CFS patients and physicians understand the condition and how this affects the clinical consultation.

Methods: Semi-structured interviews

Key: 2-2-2

Recruitment: Purposive sampling from participants within a previous study (physicians nominated eligible patients).

Analysis: Thematic analysis using constant comparison principles

Chew-Graham et al. [23]

29 practice nurses

UK (England)

Explore practice nurses’ beliefs about CFS patients and their perceived role regarding management.

Methods: Semi-structured interviews

Key: 2-2-2

Recruitment: Identified via involvement with a previous study and invited by letter/phone.

Analysis: Thematic analysis

Chew-Graham et al. [24]

22 GPs

UK (England)

Explore GPs’ views on their role in diagnosing and managing CFS patients.

Methods: Semi-structured interviews

Relevant: 2-2-1

Recruitment: Identified via involvement with a previous study and invited by letter/phone.

Analysis: Thematic analysis

Chew-Graham et al. [25]

19 patients

UK (England)

Establish important factors for patients engaging in a CFS intervention and make recommendations for GP on referring patients to such a service.

Methods: Semi-structured interviews

Key: 2-2-2

Recruitment: Identified GPs within a previous study and asked them to refer registered CFS patients to the study.

Analysis: Thematic analysis

Clarke [26]

60 patients

Canada

Describe the way in which CFS patients seek confirmation and legitimisation of their illness.

Methods: Open-ended focused interviews

Relevant: 2-2-1

Recruitment: Patients contacted through CFS support groups and invited to participate via letter.

Analysis: Cross-case analysis

Dickson et al. [27]

14 patients

UK (Scotland)

Explore patients’ experiences of living with CFS.

Methods: Interviews

Relevant: 2-2-1

Recruitment: Patients contacted through alternative therapy clinics (Reiki) or personal contacts.

Analysis: Interpretative Phenomenological Analysis (IPA)

Edwards et al. [28]

8 patients

UK (England)

Explore the experiences of living with CFS to increase insight into the experiences of and difficulties faced by people with this condition.

Methods: Semi-structured interviews

Relevant: 1-2-2

Recruitment: Members of an ME self-help network were recruited via posters and email.

Analysis: IPA

Gilje et al. [29]

12 patients

Norway

Explore obstructions for quality care experienced by people with CFS

Methods: Group interview

Key: 2-2-2

Recruitment: Purposive sampling from patient organisation.

Analysis: Systematic text condensation (Giorgi, 1985)

Guise et al. [30]

38 patients

UK (Scotland)

Explore the interactions between health professionals and patients with CFS. Targeting sensitive issues in an online environment and exploring how the accounts were constructed.

Method: Non-directive discussion topic in an online forum.

Key: 2-2-2

Recruitment: Patient support group invitation

Analysis: Discursive analysis

Hannon et al. [5]

44 (9 GPs, 5 Practice Nurses, 4 CFS/ME specialists, 10 carers and 16 patients)

UK (England)

Explore patient, carer and health professional’s views on the development of CFS/ME training and resources for primary care.

Methods: Semi-structured interviews

Key: 2-2-2

Recruitment: Invited by letter/phone.

Analysis: Thematic analysis.

Horton et al. [31]

6 health professionals

UK (England)

Explore healthcare professionals views of best practice.

Method: Semi-structure interview with developed topic guide

Key: 2-2-2

Recruitment: Nominated by members of England-wide study.

Analysis: Thematic analysis.

Horton-Salway [32]

10 GPs

UK (England)

Explore GP’s construction of CFS/ME patient identities and the definition of their illness.

Method: Unstructured broad theme one-to-one interviews.

Relevant: 2-2-1

Recruitment: Nominated by members of a patient support group

Analysis: Discourse analysis.

McDermott et al. [33]

20 patients

UK (England)

Explore hopes and expectations of patients newly referred to CFS service (Department of Health/National Institute of Health and Clinical Excellence).

Method: Semi-structure interview with developed topic guide

Key: 2-2-2

Recruitment: Invitation letter sent to patients newly referred to specialist CFS service by their GP.

Analysis: Constant comparative analysis.

Peters et al. [34]

46 patients, 3 nurses and 2 supervisors

UK (England)

Identify potential barriers and solutions for general nurse practitioners in implementing

Method: Mixed methods nested qualitative study. Semi-structured interview with developed topic guide

Key: 2-2-2

   

psychosocial interventions to people with CFS. Taken from 3 perspectives (the nurses delivering the intervention, the patients and supervisors).

Recruitment: Purposive and matched sampling (age etc)

 

Analysis: Thematic analysis.

Raine et al. [35]

46 GPs

UK (England)

Explore GPs perspective about CFS and irritable bowel symptoms and how they should be treated.

Method: Nominal groups (clinical guideline opinion groups). Scenario evaluation.

Relevant: 2-2-1

Recruitment: Random sample

Analysis: Grounded theory variant.

Schoofs et al. [36]

16 patients

USA

Expand upon quantitative quality of life measurements to understand how healthcare (diagnosis and management) impacts upon quality of life for people with CFS and Fibromyalgia.

Method: Mixed method design. Semi-structure telephone interview.

Relevant: 2-1-1

Recruitment: Convenience sample from 3 local support groups.

Analysis: Constant comparative analysis.

Woodward et al. [37]

20 GPs and 50 patients

Australia

Compare GP and patients perspective of CFS and its management.

Method: Semi-structure interview with developed topic guide

Relevant: 2-1-1

Recruitment: GPs recruited from Royal College. Unclear how patients were recruited.

    

Analysis: No analytic procedure defined. Mixed quantitative e.g. “50% of doctors believed…”