Background Gout disease is common and potentially serious due to its joint, renal and cardiovascular complications. It is well treated with multiple efficient treatments; however, we notice a lack in the medical care of this disease, especially due to a bad compliance with the treatment. This compliance depends of numerous factors as personal history of the patient, relation to the healthcare system, social and familial environment.
Objectives To explore knowledge, beliefs and representations of gout with gout patients followed in general practice and hospital rheumatology
Methods Qualitative study by semi directive interviews of gout patients followed by general practice. Population: 26 patients, with 14 patients followed in general practice (22 men) from 44 to 85 yo sampled for their familial situation, ethnical origin and comorbidities. The areas explored concerned the disease itself, the medical care, the family and professional environment, and the health care system. The interviews were recorded and then analyzed through the grounded theory model: encoding of the interviews as we go along until data saturation. The codes are combined into sets and then analyzed in order to deduct concepts with the Nvivo 10 software.
Results Emerging concepts: shameful disease, traumatic disease on a physical level (painful and disabling), and on a psychic level (self-image damaged). Nevertheless, even if the disease is considered as trivial, it is for most of the patients like the sword of Damocles: permanent fear for the next attack. Each patient had its own physiopathological conception, a wrong one most of the time. For example, they believe the disease was directly link to a personal responsibility (bad food hygiene…) or linked to an external cause (professional diner, heredity…). Gout attack triggered by overeating was often reported, due to a trust relationship between patient and medical doctors. Most of the patients were counting on their wife or husband to manage treatment, diet and familial organization. The role of the diet was predominant for the medical care, much more than the hypo-uricemiant treatment. But it appeared that the diet was binding with questioning of the lifestyle, and was managed day by day. There was not much difference between the patients of general medicine and those of rheumatology.
Model of a relation between medical care – disease – patient: each patient develops its own gout under different influences: his life, returned image, information received. All this creates a unique entity, with a particular physiopathology… And a proper medical care modeled by experience, family, doctor and information. Then there is a balance between benefits and barriers to observance.
Conclusions The very personal and intimate vision of gout disease and its treatment by the patients should be taken into account in therapeutic education.
Disclosure of Interest None declared