Info exchange or discussion? ... collaboration between social security service & healthcare service for patients with chronic fatigue,2025,Haghshenas

[Dolphin]

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Information exchange or discussion? A qualitative study on cross-sectoral collaboration between social security service and healthcare service for patients with chronic fatigue - BMC Health Services Research

Chronic fatigue, with or without an identified underlying cause, can severely restrict social participation, education, employment, and daily activities, o

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Information exchange or discussion? A qualitative study on cross-sectoral collaboration between social security service and healthcare service for patients with chronic fatigue​

• Research
• Open access
• Published: 09 December 2025
• article number , (2025)
• Cite this article

BMC Health Services Research

Information exchange or discussion? A qualitative study on cross-sectoral collaboration between social security service and healthcare service for patients with chronic fatigue

• Maryam Haghshenas,
• Aslak Steinsbekk,
• Tormod Landmark,
• Astrid Woodhouse &
• Karen Walseth Hara

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract​

Background​

Chronic fatigue, with or without an identified underlying cause, can severely restrict social participation, education, employment, and daily activities, often leading to long-term disability. In parallel with the health challenges, many affected individuals also seek support from social security services. While cross-sectoral collaboration between healthcare and social security service in managing chronic conditions is increasingly studied, little is known about such collaboration for patients with chronic fatigue. The aim of this study was therefore to investigate the experiences of patients with chronic fatigue of unclarified cause and social security supervisors regarding cross-sectoral collaboration between healthcare and social security services in Norway, particularly through collaborative meetings initiated by specialist healthcare service.

Methods​

A qualitative study was conducted using semi-structured individual interviews with nine patients and five social security supervisors who had participated in at least one collaborative meeting initiated by a tertiary care pain clinic at which the patients were referred to for a multidisciplinary examination. The meetings were part of a proposed care pathway for patients with chronic fatigue of unclarified cause and involved general practitioners, specialist healthcare providers, and social security supervisors. The data was analyzed using thematic analysis.

Results​

It was found that the informants experienced pre-existing relationships with social security supervisors influenced the quality of collaboration. Some had not had any contact before the first collaborative meeting. The collaborative meetings varied in depth, from basic information sharing to meaningful dialogue and planning. The meeting structure, timing of participation, and digital format affected engagement and flow. The follow-up processes were often unclear, with varying expectations about responsibilities. While informants generally valued the meetings, they emphasized that effective collaboration required continuity, preparation, and sustained engagement beyond the meeting.

Conclusion​

Collaborative meetings between healthcare and social security service were perceived as beneficial for managing complex cases of chronic fatigue. However, their effectiveness is perceived to depend on relational continuity, inclusive dialogue, and clear follow-up procedures. Structural adjustments, such as improved preparation, consistent supervisory relationships, and facilitation of shared decision-making, are suggested as actions to enhance the collaborative process and ensure person-centered cross-sectoral support for this patient group.

Data availability​

The data supporting the conclusions of this article is not openly available, but the anonymized transcripts are available from the corresponding author upon reasonable request. The data can be found at the Department of Public Health and Nursing at the Norwegian University of Science and Technology in Trondheim, Norway.

Abbreviations​

NAV:
Norwegian Labour and Welfare Administration

ME/CFS:
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

 

[Utsikt]

The only mention of ME/CFS:

Background

Chronic fatigue is associated with a variety of diseases and is common in the general population also in the absence of identified underlying pathology (1). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a diagnosis commonly applied to cases of medically unexplained, disabling fatigue that is typically accompanied by additional symptoms such as cognitive impairments and sleep disturbances (2, 3)

1. Glette M, Stiles TC, Woodhouse A, Nilsen TIL, Landmark T. Chronic fatigue in the general population: Prevalence, natural course and associations with chronic pain (the HUNT pain study). Eur J Pain. 2024;28(10):1762–71.

2. Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, D.C.: The National Academies Press; 2015.

3. Brurberg KG, Fønhus MS, Larun L, Flottorp S, Malterud K. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open. 2014;4(2):e003973.

Perhaps not the citation I would have used..

 

[Dolphin]

The only mention of ME/CFS:

1. Glette M, Stiles TC, Woodhouse A, Nilsen TIL, Landmark T. Chronic fatigue in the general population: Prevalence, natural course and associations with chronic pain (the HUNT pain study). Eur J Pain. 2024;28(10):1762–71.

2. Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, D.C.: The National Academies Press; 2015.

3. Brurberg KG, Fønhus MS, Larun L, Flottorp S, Malterud K. Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. BMJ Open. 2014;4(2):e003973.

Perhaps not the citation I would have used..

Yeah, wasn’t sure whether it should go in this subforum or not.

 

[Utsikt]

They mention chronic fatigue syndrome once, but there are 16 references in total to ME/CFS publications.

Despite its impact, people with chronic fatigue syndrome frequently experience marginalization in both healthcare and welfare systems, often encountering disbelief, inadequate support, and a lack of recognition of their condition (11).

I’m confused. They almost seem to think that CF and ME/CFS can be used interchangeably.

Setting

This study was conducted within a research project at the tertiary care outpatient multidisciplinary pain center at St. Olavs Hospital in Trondheim in Central Norway. The pain center offers multidisciplinary assessment and sometimes follow-up for patients with chronic pain or chronic fatigue, in which measures from primary care, mostly by general practitioners, or organ-specific specialists have not been adequate.

So it’s clearly not an ME/CFS project despite them using numerous ME/CFS sources.

The research project aims to improve coordination and support for patients with chronic fatigue, who are referred to the pain center by their general practitioners for evaluation of diagnosis, rehabilitation potential, and prognosis, by developing and testing a new care pathway, only introduced in the pain center in central Norway (31).

I think it’s this center. There is nothing new there, it’s BPS, so some CBT, some physio, and radiofrequency denervation (looks like it’s not supported by evidence (cochrane, other review)).

The most prominent change to previous organization of care was the introduction of video-based meetings involving the patients, their next-of-kind if desired, specialist healthcare providers, and general practitioners. In addition, social security service supervisors were also invited to the video-based meeting if patients had or were expected to require work-related support or social benefits. The meetings aimed to address this need by bringing together relevant actors to jointly evaluate patient situations and coordinate follow-up measures.

It looks like their «innovation» was to do a digital meeting with the different people involved.

Based on the quotes it doesn’t really look like it was much of a success. It appears to be going down the route of inviting everyone to a meeting, regardless of them being needed. So peak corporate culture. A lot of this could have been solved with an email to NAV (welfare authorities) etc.

My recent communication with NAV consisted of a short phone call with me telling them nothing has changed and which providers I’m talking to, and my supervisor saying there’s no need to spend more time on this so I’ll just ask you GP for documentation and everything should be sorted if your situation is as you describe (i.e. nowhere near being able to work).

 

[rvallee]

I have no idea what this is even about. It's all so damn generic and confused that it makes my political science classes look like hard science by comparison. I think they're trying to validate what they're doing? I genuinely have no idea who or what this is for.