The vicious cycle of functional neurological disorders: a synthesis of healthcare professionals' views on working with patients with functional neurological disorder

Purpose The objective of this review was to synthesise studies which address the views of healthcare professionals (HCPs) towards patients with functional neurological disorder (FND). Methods An interpretive systematised review was conducted. Seven databases were searched using a comprehensive search strategy (MEDLINE, EMBASE, AMED, CINAHL, PsychINFO, ProQuest Nursing and Allied Health, and Scopus). Qualitative studies and those using survey methods were included. An inductive approach to thematic analysis was used to identify concepts from the data and to synthesise the results. Results The views of 2769 HCPs were represented in 11 included articles. The overarching theme across the articles was uncertainty: about making the diagnosis of FND, about professional roles, and about optimum management. Fear was also a common theme: of saying the wrong thing, of offending patients, or of breaking the therapeutic relationship. Conclusions If all HCPs felt uncertain about how to manage patients with FND and avoided them by passing them on to another discipline, then a vicious cycle is formed in which patients are passed from one professional to another but without receiving clear, honest information, or effective treatment. HCPs would benefit from increased training on FND and clear clinical pathways to alleviate feelings of uncertainty.

Automated summary

This review examines the views of healthcare professionals towards patients with functional neurological disorder (FND). The study found that healthcare professionals experience uncertainty in diagnosing FND, defining their professional roles, and determining the best management for FND patients. Fear of saying the wrong thing, offending patients, or damaging the therapeutic relationship is also common among healthcare professionals. If healthcare professionals are uncertain about how to manage FND patients and pass them on to other disciplines, a vicious cycle is formed where patients are continuously passed on without receiving clear information or effective treatment. Increased training on FND and the establishment of clear clinical pathways could help alleviate healthcare professionals' uncertainty.