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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…”