Gisela Ringstrom, PhD, RN

Henrik Sjovall, PhD, MD

Magnus Simrn, PhD, MD
Eva Jakobsson Ung, PhD, RN

The Importance of a Person-Centered

Approach in Diagnostic Workups of
Patients With Irritable Bowel Syndrome
A Qualitative Study

ABSTRACT
The aim of this study was to explore experiences of undergoing a diagnostic workup in patients with irritable bowel
syndrome (IBS) at a unit for functional gastrointestinal disorders. Research has been sparse in addressing such experiences and the impact on well-being. Patients with IBS were invited to perform a workup of gastrointestinal tests. Of
120 patients who completed the tests, 20 were invited for an interview. Analysis of interviews was conducted through
interpretative phenomenological analysis. One master theme emerged: validation of IBS experience inferred from
three subthemes: the duality of suffering in IBS, coping with inflicted discomfort and pain, and capacity for resilience.
Patients reported long-term suffering from symptoms including poor management within the healthcare organization. Despite inconvenience associated with the tests, patients expressed appreciation for professional attributes such as attentiveness that were perceived as a sense of being cared for and seen as a person. During the workup, patients acquired greater
knowledge of what IBS means, including knowledge about their own body functions and experienced relief that symptoms
were not caused by any dangerous disease. Validation of IBS experience surfaced in the data implying that in such context,
patients with IBS appear to find personal solutions to cope with everyday experiences and enhance autonomy.

rritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder with a prevalence of
approximately 3%20% (Grundmann & Yoon,
2010). Irritable bowel syndrome is defined as a
chronic condition characterized by a combination of
abdominal pain or discomfort and altered bowel habit
(Spiller et al., 2007). Besides the suffering that IBS

symptoms arguably inflict, there are numerous empirical studies that have linked IBS to work absenteeism,
reduced quality of life, and psychological distress.
Furthermore, there is to date no drug or medical remedy that has been shown to cure IBS symptoms
(Kellow, Eckersley, & Jones, 1991; Whitehead &
Palsson, 1998).

Received March 27, 2012; accepted June 27, 2012.

Magnus Simrn received unrestricted research grants from Danone and

AstraZeneca and served as a Consultant/Advisory Board member for
AstraZeneca, Danone, Novartis, Almirall, and Shire/Movetis.

About the authors: Gisela Ringstrom, PhD, RN, is Head Nurse,

Department of Internal Medicine, Institute of Medicine, Sahlgrenska
Academy and University of Gothenburg Centre for Person-Centered
Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Henrik Sjovall, PhD, MD, is Professor, Department of Internal Medicine,
Institute of Medicine, Sahlgrenska Academy and University of
Gothenburg Centre for Person-Centered Care (GPCC), University of
Gothenburg, Gothenburg, Sweden.
Magnus Simrn, PhD, MD, is Professor, Department of Internal
Medicine, Institute of Medicine, Sahlgrenska Academy and University of
Gothenburg Centre for Person-Centered Care (GPCC), University of
Gothenburg, Gothenburg, Sweden.
Eva Jakobsson Ung, PhD, RN, is Senior Lecturer and Associate
Professor, Institute of Health and Care Sciences, Sahlgrenska Academy
and University of Gothenburg Centre of Person-Centered Care (GPCC),
University of Gothenburg, Gothenburg, Sweden.

VOLUME 36 | NUMBER 6 | NOVEMBER/DECEMBER 2013

This study was supported by the Swedish Medical Research Council

(grants 13409, 21691, and 21692), The Marianne and Marcus
Wallenberg Foundation, University of Gothenburg; Centre for PersonCentered Care (GPCC), Sahlgrenska Academy, University of Gothenburg;
the Faculty of Medicine, University of Gothenburg; and The Health and
Medical Care Committee of the Regional Executive Board, Region
Vstra Gtaland.
The other authors declare no conflict of interest.
Correspondence to: Gisela Ringstrom, PhD, RN, Department of Medicine,
Institute of Medicine, Sahlgrenska Academy and University of Gothenburg
Centre for Person-Centered Care (GPCC), University of Gothenburg,
Gothenburg, Sweden (gisela.ringstrom@vgregion.se).
DOI: 10.1097/SGA.0000000000000011

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A Person-Centered Approach in Diagnostic Workups of Patients With IBS

Given its prevalence and the medical enigma that

IBS constitutes, the relatively large number of studies
that this domain has accumulated seems warranted.
Studies with quantitative research approaches have by
large focused on the etiology of IBS (Ohman & Simren,
2007) and various interventions aimed at symptom
reduction (Ford et al., 2008; Ford, Talley, Schoenfeld,
Quigley, & Moayyedi, 2009; Moayyedi et al., 2010).
Studies with qualitative research approaches have in
contrast directed most attention toward the sometimes
negative, judgmental, and problematic encounter that
patients with IBS have with healthcare professionals,
and the difficulties that living with IBS may imply
including extensive focus on negative symptom experiences (Drossman et al., 2009; OSullivan, Mahmud,
Kelleher, Lovett, & OMorain, 2000).
Although research and common sense suggest that
IBS is a disabling and unpleasant condition, it might be
useful to expand the number of vantage points
employed when attempting to understand this phenomenon. One way of doing this is to shift focus to
also incorporate conceptualizations that are adaptive
and positive for patients. This approach has the advantage of establishing ways in which patients better can
manage and reduce their symptoms and negative experiences. The aim of the current research is thus to
explore the experience and meaning that IBS patients
attribute to undergoing a diagnostic workup at a unit
for functional GI disorders. This exploration will be
permeated by a quest to explore how patients conceptualize this experience with regard to their own wellbeing. A further endeavor is to elucidate the means
through which patients cope, adapt, and somehow
manage what at face value would appear to be an invasive and precarious procedure.

Review of the Literature

Pertinent research in IBS is (broadly speaking) assigned
to those inquiries that are concerned with the difficult
and problematic encounter with healthcare that
patients with IBS may endure. In addition, several
studies in this domain have been carried out within the
remit of exploring patients quest, and seeking for a
diagnosis and the answers that this endeavor may hold
(Kennedy, Robinson, & Rogers, 2003; Meadows,
Lackner, & Belic, 1997).
Studies on satisfaction with healthcare provision
among patients with IBS suggest that their self-perception as patients often is problematic and the time
before diagnosis is challenging. Patients frequently
report an array of concerns regarding their symptoms,
but findings from pertinent studies suggest that healthcare providers often fail to make patients feel validated
and taken seriously (Bengtsson, Ohlsson, & Ulander,
2007; Bertram, Kurland, Lydick, Locke, & Yawn,

2001; Casiday, Hungin, Cornford, de Wit, & Blell,

2009; Hakanson, Sahlberg-Blom, & Ternestedt, 2010;
Meadows et al., 1997).
These suggestions are consistent with studies that
have pointed out that patients tend to report a need to
justify their medical concerns, the way in which this is
attended to by the healthcare domain is unsatisfactory,
and sometimes entail demeaning attitudes (Bengtsson
et al., 2007). It is, therefore, no surprise that patients
with IBS tend to report a sense of abandonment and
frustration (Casiday et al., 2009). Many patients also
report that their symptoms of IBS are associated with
a sense of shame and taboo. There is consequently a
reluctance to openly discuss these issues with healthcare professionals (Hakanson et al., 2010; OSullivan,
et al., 2000).
Obtaining a diagnosis of IBS is typically described
as a confusing and frustrating process for both patients
and physicians, which in part may be due to patients
expectancy to receive more diagnostic tests than what
clinical practitioners use (Bijkerk et al., 2003;
Whitehead & Palsson, 1998). Studies also suggest that
obtaining a diagnosis early is very important for
patients with IBS (Bengtsson et al., 2007; Spiller et al.,
2007). However, attitudes and clinical practice regarding the diagnostic process differ depending on the
specific healthcare setting in which patients are seen
(Lacy et al., 2006).
Irritable bowel syndrome can be diagnosed on the
basis of patients self-reported symptoms (Longstreth
et al., 2006). However, to rule out medically more
severe conditions, such as inflammatory bowel disease
and cancer, patients with IBS may have to undergo
invasive and relatively stressful procedures such as
gastroscopy and colonoscopy. It is, therefore, understandable that patients report feeling frustrated when
they are told that nothing was found (Spiegel et al.,
2005).
Many patients with IBS seem to hold misconceptions about their condition and are interested in learning more about the disorder (Halpert et al., 2007; Lacy
et al., 2006). Given the fluctuating nature of IBS symptoms and the level of variance between different
patients, it seems highly relevant to teach patients
about their condition in a fashion that is personalized
(Casiday et al., 2009; Hakanson et al., 2010; Spiller
et al., 2007).
In summary, the vast majority of the aforementioned studies have aimed to investigate the experience
of living with IBS and how the patients experience
their encounters within the healthcare system. In a
previous study, patients with IBS were invited to
perform a diagnostic workup. The aim was to find
functional disturbances in the GI tract that might
explain IBS symptoms. Although some research has

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A Person-Centered Approach in Diagnostic Workups of Patients With IBS

been carried out regarding the satisfaction with healthcare in patients with IBS, little research has directly
addressed patients experiences of undergoing a structured workup. The aim of the current study was, therefore, to explore the experiences of undergoing such
procedures in patients with IBS as well as the implications for their well-being. Rather than proposing an
increase in specialized healthcare for patients with IBS,
this study strives to contribute to the overall knowledge base. The hope is that this, in turn, could enhance
the way in which IBS patients are cared for within the
healthcare structure in general and perhaps within primary care in particular.

Methods
This study has adopted a qualitative methodology
referred to as interpretative phenomenological analysis. Interpretative phenomenological analysis is a
method concerned with exploring the meaning that
people ascribe to major life events (Smith, Flowers, &
Larkin, 2009; Willig, 2008) and is underpinned by
phenomenology and hermeneutics whereby the use of
the researchers interpretation is seen as a vital tool.
The rationale for the chosen approach is the ambition
to gain a deeper understanding of the meaning that
patients assign to undergoing a structured diagnostic
workup.
The current research assumes an epistemological
vantage point based on the premise that humans subjective and different ways of experiencing the world
are valid and of equal importance as well as essential
for increased knowledge within the scientific community. This notion is paired with a more realist perspective wherein it is acknowledged that some level of
universally constructed reality may coexist with subjective experiences.

The Diagnostic Workup

Between 2003 and 2007, 150 people diagnosed with
IBS were invited to perform a structured diagnostic
workup at a unit for functional GI disorders in
Sweden. One hundred twenty patients completed the
workup comprising the following:
Small bowel manometry and measurement of potential difference measurement as a measure of small
intestinal motor and secretory function (Larsson
et al., 2007).
Rectal balloon distension as a measure of rectal sensitivity (Posserud et al., 2007).
Oro-anal transit time measurement with radiopaque
markers as an indirect measure of colonic motor
function (Tornblom et al., 2012).
A follow-up visit with a gastroenterologist, where
the results from the investigations were thoroughly
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explained and discussed with the patient. A personcentered approach was used during the visit, aimed
at gaining a better understanding of the patients
symptom experience and the impact on daily life.
Moreover, the emphasis during the consultation was
on trying to explain mechanisms underlying the
symptoms and to discuss how the symptom burden
could be reduced. Based on this, a treatment plan
was initiated that could consist of pharmacological
and nonpharmacological treatment options. During
this visit, previous investigations and laboratory
tests were reviewed, information about IBS was provided, and consequences of this diagnosis were discussed with the patient.
The tests were performed by nurses and physicians.
The workup comprised four visits with a duration
ranging between 30 minutes and 6 hours during a
period of 3 months. The patients were informed
regarding the aim of the assessment.

Participants
A sample of 20 patients of those patients who completed the workup as a whole were invited to an interview. The sample consisted of 16 women and four men
(mean age 46 years, range = 2774 years). All participants had long experience of living with IBS. The average IBS duration was 24 (range = 765) years.

Data Collection
To capture participants lived experiences, data were
collected by means of using semistructured interviews
that provided participants with an opportunity to
share their personal experiences with the researcher.
Patients were asked to describe the experiential meaning of the diagnostic workup. The inputs that patients
provided during the interviews were followed up with
further probes to encourage participants to elaborate
(Willig, 2008). The interviews were recorded on tape
and transcribed verbatim.

Data Analysis
The analysis was carried out using the following
procedure:
1. The content of the 20 interviews was read individually by three of the authors a number of
times to develop an impression of the experience
of each participant. Wide-ranging and unfocused
notes that reflected initial thoughts were thereafter made.
2. Following the initial engagement with the data,
interviews were read systematically to identify
themes. Each of the interviews was read line by
line to capture what was represented in the text
through thematic labels. Those themes that
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A Person-Centered Approach in Diagnostic Workups of Patients With IBS

shared reference points were clustered (e.g., earlier experience of healthcare, experiences of the
diagnostic workup, and consequences of the
workup). A summary table was produced for
each participant.
3. To obtain a generalized understanding of the
participants experiences as a whole, the summary table for each participant was integrated
into an inclusive list of themes. The process of
integration was carried out in a cyclical manner
whereby any emerging high-order themes were
checked against the transcripts, ensuring that
they were grounded in data. Following this procedure, one master theme was identified: validation of IBS experience comprising three superordinate themes: the duality of suffering in IBS,
coping with inflicted discomfort and pain, and
increased capacity for resilience.
Throughout the aforementioned procedure, an
emphasis on using interpretation as a tool for understanding was made. This interpretation has been permeated by the researchers understanding and previous
clinical experience of IBS. These preconceptions have
been used when interpreting the data that have
emerged in conjunction with the epistemological stance
that has been undertaken.
To validate the interpretation and analysis of the
data, the authors were working collaboratively during
the course of analysis. Codes, constituent themes, and
master theme were (a) simultaneously analyzed independently by the authors and (b) continuously compared until consensus was reached. Furthermore, similarities within and differences between the themes were
judged by all the authors. To describe the results, data
were arranged into themes in which the patients own
words have been intertwined with the descriptions to
strengthen the reliability of the results.

Ethical Considerations
This study was carried out following approval from
the Regional Ethical Review Board of the University of
Gothenburg. Participants were informed about the
purpose of the study and the procedure involved in the
interview. Participants were also informed about their
right to withdraw at any time that interviews would be
tape recorded and transcribed, as well as the emphasis
on removing all identifying details from interviews to
ensure patient confidentiality. Both verbal and written
consent were obtained at the time of the interview.

Results
Through the analysis of data, one master theme
emerged: validation of IBS experience. This master
theme was inferred from three superordinate themes:
the duality of suffering, coping with inflicted discomfort and pain, and capacity for resilience (Figure 1).

The Duality of Suffering in IBS

This theme transpired through the analysis and is
referring both to the suffering that patients had experienced in terms of their IBS symptoms, and to the
suffering that was associated with being poorly managed and treated within the healthcare organization.
Participants described a sense of negative estimation of
themselves as problematic and bothersome patients.
This view was verbalized as a notion of having received
a mock diagnosis, which means that they in some
ways feel like a hypochondriac. The symptom-related
suffering, on the other hand, was experienced as cumbersome and impairing daily life during a lengthy
course of time.
Patients express having experienced a long journey
through the healthcare system lasting several years
with repeated visits to various general practitioners,
specialists, and emergency departments when the

FIGURE 1. Patients experience of undergoing a diagnostic workup in irritable bowel syndrome (IBS).
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A Person-Centered Approach in Diagnostic Workups of Patients With IBS

symptoms of IBS had become too intense. Patients

sought an answer as to why they were affected by their
symptoms without being given a satisfactory answer.
One patient described this experience:
Ive asked for all the help available, Ive been to all the
available doctors, acupuncturists, and all the private
practitioners who are involved in this, everything.

Patients also expressed that their encounters with

healthcare professionals have been characterized by
protocol-driven treatment, incompetence, and a highly
limited amount of meaningful interactions with professionals. Subsequently, patients seem to have developed
a lack of trust in competence of other caregivers in relation to the assessment and treatment of IBS. This
includes things that were missed in earlier workups,
perceptions that they were not properly examined, and
criticism of the inadequate treatment of symptoms with
drugs that rarely had the desired effect. Patients also
spoke of having experienced a demeaning treatment in
terms of patronizing symptoms or ascribing them to
psychological distress. In some cases, this adverse treatment seems to have spiraled into what has been experienced as contempt by patients. One patient told:
When I was visiting a doctor, I was told that I suffered
from gastritis and that I should stop stressing. Now I
have proof of what I am saying. Im no longer dismissed.

Coping With Inflicted Discomfort and Pain

When exploring this theme, it became evident that
patients described feeling highly motivated and willing
to undergo the workup. This willingness of participating was contextualized against the backdrop of patients
negative experience when being treated in the healthcare system for their IBS symptoms in the past. Patients
also depict that the tests in the workup were seen as
invasive and painful and evoke feelings of panic, humiliation, and vulnerability. As one patient noted:
The entire issue is controversial and surrounded by a
taboo and these kinds of procedures are hence quite
unpleasant. However, in order to get answers, youre
willing to put up with almost anything.

Another patient expressed a similar view:

I did it in order to get a more endurable life.

As a means to contextualize the passages given earlier, some patients described manometry as a highly
unpleasant procedure because they experienced a
strong sense of suffocation, a strong urge to vomit,
pain, and feelings of panic during the test. Furthermore,
VOLUME 36 | NUMBER 6 | NOVEMBER/DECEMBER 2013

a number of patients regarded the rectal sensitivity test

as painful, exposing, and humiliating. However,
patients expressed that they did not experience the
most important benefit to be the tests per se. Instead,
the contact and relationships with health care professionals such as doctors and nurses were emphasized as
being a vital aspect. This was exemplified by one
patient who expressed:
I did not benefit that much from participating in the
workup as such but more so from meeting the staff at the
gastrointestinal unit.

The pleasant atmosphere at the unit (i.e., calm and

quiet) and the professional and respectful manner in
which they were treated by staff brought about a spontaneously positive response from patients. That is,
patients seem to have felt that they were genuinely
understood and listened to and felt that they were well
cared for in conjunction with the tests. Patients also
seemed to have valued staff attributes such as being
professional, open, welcoming, accommodating, and
attentive. On the whole, this contributed to patients
not feeling exposed.
The follow-up discussion with a gastroenterologist
was affirmative for patients, who expressed faith in the
doctors expertise and their appreciation of the doctors commitment. One experience that patients appear
to have perceived during the workup as particularly
poignant and meaningful concerns the notion of being
cared for and seen as a person. Irrespective of how
they perceived the various aspects of the workup,
patients appeared willing to undergo the workup
again. However, some patients expressed their disappointment or surprise regarding the lack of objective
findings.

Increased Capacity for Resilience

When the patients were asked to explain in their own
words what the workup meant for them, it transpired
that it had widespread consequences in terms of their
capacity for resilience. That is, patients acquired a
greater knowledge of what IBS means to them and
how their own body functions, and they felt relieved
that symptoms were not caused by any dangerous
disease.
The data appear to suggest that the workup as a
whole began as a learning process that generated knowledge that varied in nature. On the one hand, patients
learned more overarching and theoretical aspects that
increased knowledge of IBS in general. On the other
hand, patients also gained concrete insight in terms of
how their own body functions. Patients highlighted
forms of learning such as information opportunities,
explanations, dialogues, and the fact they were given the
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opportunity to ask healthcare professionals questions.

One patient explained this as:
Each time I was at the unit, I learnt a bit more. It helped
a great deal. You are given so much information. It is
through that specific information that I have gained a
different perspective on my problems.

Of most importance for patients seemed to be that

someone who was knowledgeable and trustworthy
confirmed that their symptoms were not due to a
malignant disease. Patients also seem to have appreciated that healthcare staff seemed thorough in terms of
how they approached patients symptoms that provided a sense of fulfillment. Patients had experienced
concern over a long period about the symptoms. In
conjunction with the workup, they described a clear
relief from distress. They were relieved and felt a sense
of calmness. However, in this context, various attitudes
emerged about being diagnosed with IBS. Some of the
patients were of the opinion that IBS is a functional
deviation and accepted that it is not always possible to
demonstrate these deviations. One patient said:
This IBS phenomenon isnt anything really serious. The
more serious conditions could be excluded.

Other patients felt happy and relieved that the

workup indicated that they were not suffering from any
serious disease, but found it more difficult to accept the
lack of objective findings. One patient held this view:
Youre really happy that they couldnt find anything
wrong although you still feel good grief, I feel that
something isnt right, and so Im still disappointed in a
way that nothing could be found when I feel that there is
something.

Validation of Their IBS Experience

The notion of experiencing a sense of validation of IBS
was a theme that in many ways surfaced in and
instructed the data set as a whole. Patients stated that
they felt their problems were confirmed as real and
authentic and that they could put a name to it. Some
patients spoke in terms of the workup showing that
they were not hypochondriacs as one patient expressed:
Its not me that is imagining things as someone who is a
hypochondriac would do. They found something, which
is good. It was confirmed that its not something wrong
with me.

Validation of IBS experience was also a theme that

was considered to be closely linked to the superordinate themes that have been outlined previously. It
clearly transpires throughout the data that suffering

and unpleasant experience were aspects of the overall

package deal that patients appeared capable (and
sometimes even willing) to endure provided that their
experiences were validated as opposed to dismissed or
treated in a demeaning manner. That is to say, patients
appear to emphasize the experiential meaning of having encounters that as far as possible are absent from
judgmental attitudes and protocol-driven treatment. In
this sense, the key issue is arguably more about how a
workup is conducted as opposed to what the different
tests comprise.
The diagnostic workup did not necessarily result in
any objective findings, but the confirmation implied
that patients could easier come to terms and cope
with their difficulties, and perhaps most importantly,
find their own unique solutions to manage their everyday experiences and enhance their autonomy as
patients and as people. Overall, the workup was a
turning point for many patients and they stated that
they had acquired a different perspective on their
problems. This meant that patients considered their
situation as more manageable and felt more able to
cope and also increased their capacity for resilience.
One patient said:
I have stopped ruminating. You learn how to handle it.

Discussion
This study suggests that a person-centered approach to
care is beneficial during diagnostic processes in patients
with IBS, which seems to have a considerable impact
on these patients well-being. All patients included in
this study had long-term experience in terms of being
treated within a healthcare structure. Previous research
has also pointed out that these experiences are far
from always positive (Bengtsson et al., 2007; Hakanson
et al., 2010; Lacy et al., 2006).
Many patients with IBS struggle to be acknowledged and treated in an adequate manner within the
healthcare organization. Considering that patients
with IBS often are anxious regarding their symptoms,
this could serve to exacerbate an already-difficult
situation. This means that patients with IBS are in a
vulnerable position during their encounters with
healthcare professionals.
This study also transpired that despite the patients
presumptions and experiences that they could be
treated in a condescending and demeaning manner,
patients were willing to carry out the diagnostic
workup. Patients with IBS tend to be pursuing answers
regarding their difficulties. This quest means that they
are vulnerable in terms of the physical and psychological distress they might be exposed to as part of
various medical procedures. However, in most patients
with IBS, a minimum of medical procedures could be

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sufficient to confirm the diagnosis while it could be

necessary to expand the assessment in some patients.
Patients in this study had the experience of a lengthy
referral process and hence appreciated ultimately being
treated in an adequate and professional manner. Patients
highlighted the importance of being diagnosed in an
environment that was respectful and empathic. This, in
combination with staff members high level of competence, was characterized as a positive turning point.
This is consistent with previous research that has also
proposed that it is overly simplistic to view this issue as
being underpinned only by the interaction between physician and patient (McCormack, Karlsson, Dewing, &
Lerdal, 2010). Instead, the current study suggests that
the importance of being cared for in some ways could
be conceptualized as a package deal. In this sense, it
seems more important to embrace an ethos of personcenteredness during diagnostic workups rather than
focusing on any particular instances or relationship.
Furthermore, patients emphasized that interpersonal
competence was ranked higher than technical and theoretical skills within the medical field.
Patients reported a great deal of satisfaction with
the insights and knowledge that they acquired during
the diagnostic workup. Previous research suggests that
patients with IBS have a varied need to learn about
their condition and related symptoms. It has also been
proposed that learning within an IBS context could be
problematic in those instances when advice given by
professionals is inconsistent with the physical experience of IBS (Hakanson et al., 2010). It is, therefore,
essential to employ a person-centered approach whereby each patient is considered as an expert on their own
individual experiences. This would, in turn, mean that
information, teaching, and advice could be designed in
ways that are tailored toward personal needs.
Mead and Bower (2000) argue that patient-centered
professionals need to carry their expertise invisibly
if they want to be effective. They do not apply the
information or knowledge of patients or provide information on how to behave to achieve change. Instead,
the emphasis is on facilitating a care environment
wherein patients are viewed as able to enhance their
ability to manage symptoms more independently. The
benefit of this approach rests upon the fact that
enhanced patient autonomy would decrease the
patients need to consult healthcare services, which in
itself could be empowering.

Limitations
One methodological aspect of this study that potentially could be conceptualized as a shortcoming concerns the issue of memory. That is, there were a few
years of delay between the diagnostic workup and the
time when patients were interviewed. It is possible that
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a certain degree of memory bias may have influenced

how patients made sense of their experiences. Memory
bias is a validity issue that could be seen as a temptation for participants to reconstruct experiences and
perhaps emphasize positive memories rather than
being objective. This notion implies that patients
accounts of reality could be questioned in terms of
authenticity. However, this issue is most and foremost
an epistemological dilemma and objects the notion
that memory represents a bias of a true or universal
reality. Instead, it is argued that experience is created
through language and reflection. The way in which
participants make sense of their experience is, in this
sense, independent of the time between diagnostic
workup and interview.
Another issue of concern relates to how validity is
handled. In other words, do the data actually represent
patients experiences? This dilemma was partly managed by means of using a methodology whereby collaboration between different researchers was undertaken, and the themes and analysis that was arrived at
were calibrated and compared with each other. In
addition, an awareness and focus on how reflexivity
was used has been emphasized to enhance validity. In
this study, researchers with different backgrounds were
involved (i.e., nurses, physicians, and a psychologist).
These individuals were of varied age and gender and
also differed in terms of their perspectives and experiences of IBS patients. These varied vantage points were
explicitly discussed and reflected upon throughout the
course of this study in terms of the implication for collecting and analyzing data.

Implications for Practice

Healthcare professionals who encounter patients
with IBS should hold nonjudgmental attitudes and
should be aware of the patients sensitivity for such
attitudes. Instead of performing extensive diagnostic
workups (i.e., having to find a medical diagnosis),
professionals must accept uncertainty and lack of
treatment solutions, instead putting emphasis on alleviation of symptoms and personalized support in
learning how to live with IBS. Assessment and followup in IBS should facilitate a care environment whereby staff (physicians, nurses, psychologists, nutritionists, etc.) is knowledgeable about IBS in a broad sense
and have education competence including an authentic interest in supporting these patients in coping with
daily life.

Conclusions
The diagnostic workup did not necessarily result in
any medical findings, but the validation of the patients
IBS experience implied that patients could easier come
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A Person-Centered Approach in Diagnostic Workups of Patients With IBS

to terms and cope with their difficulties. In such context, patients with IBS appear to find their individual
solutions to cope with their everyday experiences and
enhance their autonomy as patients and as persons. In
some patients, however, abnormalities in the tests suggesting abnormal GI function were found. The abnormalities were used to explain mechanisms underlying
the symptoms during the follow-up visit with the gastroenterologist, and this link was often considered as
being helpful by the patients.
Irritable bowel syndrome care programs should
emphasize the importance of partnership between
patients and healthcare professionals whereby
familiarity and consistent relationships with healthcare professionals across time are present. Existing
knowledge about abnormal GI function in IBS
patients as a group could be used as a basis to discuss mechanisms underlying symptoms with the
individual patient.

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