Abstract：
BACKGROUND: Stigma is a social attribute that links a person to an undesirable characteristic and leads to actions that increase the social distance from that person. This includes different or discriminatory treatment. Stigma is common in healthcare, particularly in people with persistent physical symptoms (PPS) and functional disorders (FD). The aim of this study is to create a new actionable framework to aid understanding of stigmatisation in consultations about PPS/FD and to improve the consultation experiences.
METHODS: This framework development used the Best Fit Framework approach to data collected for a scoping review of stigma in functional disorders. The stages included selection of an initial framework from existing conceptual models, mapping quote data from published papers to the framework and an iterative process of revision and re-mapping. The final framework was tested by re-mapping all the quote data to the framework following classification rules.
RESULTS: 253 quotes were obtained from the results sections of qualitative studies from a previous scoping review. The framework comprises of prejudice, stereotypes and actions to increase social distance. Stereotype refers to the focus of stigma: this may be the condition, the patient, or their behaviour. Actions that increase social distance include: othering; denial; non-explanation; minimising, norm-breaking; and psychologising. By breaking down stigma into recognisable components, the framework provides a way to understand the difficulties that patients and clinicians face during consultations and a way to develop intervention materials.
CONCLUSIONS: This new framework for stigma in clinical consultations for PPS/FDs provides a useful tool for the study of stigma in clinical consultations.
METHODS: This framework development used the Best Fit Framework approach to data collected for a scoping review of stigma in functional disorders. The stages included selection of an initial framework from existing conceptual models, mapping quote data from published papers to the framework and an iterative process of revision and re-mapping. The final framework was tested by re-mapping all the quote data to the framework following classification rules.
RESULTS: 253 quotes were obtained from the results sections of qualitative studies from a previous scoping review. The framework comprises of prejudice, stereotypes and actions to increase social distance. Stereotype refers to the focus of stigma: this may be the condition, the patient, or their behaviour. Actions that increase social distance include: othering; denial; non-explanation; minimising, norm-breaking; and psychologising. By breaking down stigma into recognisable components, the framework provides a way to understand the difficulties that patients and clinicians face during consultations and a way to develop intervention materials.
CONCLUSIONS: This new framework for stigma in clinical consultations for PPS/FDs provides a useful tool for the study of stigma in clinical consultations.
摘要：
背景：污名是一种社会属性，将一个人与不良特征联系起来，并导致增加与该人的社会距离的行为。这包括不同的或歧视性的待遇。耻辱在医疗保健中很常见，特别是在患有持续性身体症状（PPS）和功能障碍（FD）的人群中。这项研究的目的是创建一个新的可行框架，以帮助理解有关PPS/FD的咨询中的污名化，并改善咨询经验。
方法：该框架开发使用了最佳拟合框架方法来收集数据，以对功能障碍中的污名进行范围审查。这些阶段包括从现有的概念模型中选择初始框架，将已发表论文的引用数据映射到框架，以及修订和重新映射的迭代过程。通过按照分类规则将所有报价数据重新映射到框架来测试最终框架。
结果：253条引文来自先前的范围界定综述的定性研究的结果部分。该框架包括偏见，刻板印象和行动，以增加社会距离。刻板印象是指污名的焦点：这可能是条件，病人,或他们的行为。增加社会距离的行动包括：其他；否认；不解释；最小化，打破规范；和心理学。通过将污名分解为可识别的成分，该框架提供了一种方法来了解患者和临床医生在咨询过程中面临的困难，并提供了一种开发干预材料的方法。
结论：这一新的PPS/FD临床会诊中的污名化框架为临床会诊中的污名化研究提供了一个有用的工具。
方法：该框架开发使用了最佳拟合框架方法来收集数据，以对功能障碍中的污名进行范围审查。这些阶段包括从现有的概念模型中选择初始框架，将已发表论文的引用数据映射到框架，以及修订和重新映射的迭代过程。通过按照分类规则将所有报价数据重新映射到框架来测试最终框架。
结果：253条引文来自先前的范围界定综述的定性研究的结果部分。该框架包括偏见，刻板印象和行动，以增加社会距离。刻板印象是指污名的焦点：这可能是条件，病人,或他们的行为。增加社会距离的行动包括：其他；否认；不解释；最小化，打破规范；和心理学。通过将污名分解为可识别的成分，该框架提供了一种方法来了解患者和临床医生在咨询过程中面临的困难，并提供了一种开发干预材料的方法。
结论：这一新的PPS/FD临床会诊中的污名化框架为临床会诊中的污名化研究提供了一个有用的工具。
