Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol

BACKGROUND: Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.

OBJECTIVE: To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.

DESIGN: Randomized, single-blind feasibility study.

SETTING: University-based geriatric and internal medicine primary care clinics.

PATIENTS: 45 patients 66 years of age or older without a psychiatric diagnosis.

INTERVENTION: Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).

MEASUREMENTS: The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.

RESULTS: One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.

CONCLUSIONS: Findings support the feasibility of implementing the protocol as a primary care intervention.