Understanding Veterans' Causal Attributions of Physical Symptoms

'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness

Objective: Medically unexplained symptoms (MUS), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are difficult to treat. Concordance-shared understanding between patient and provider about illness causes, course, and treatment-is an essential component of high-quality care for people with MUS. This qualitative paper focuses on the experiences of United States military Veterans living with GWI who have endured unique healthcare challenges. Methods & Measures: Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contribute to and detract from concordance with their Veteran Affairs (VA) healthcare providers. In addition to being seen by VA primary care, over half of participants also sought care at a War Related Illness and Injury Study Center, which specializes in post-deployment health. Deductive and inductive codes were used to organize the data, and themes were identified through iterative review of coded data. Results: Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/MUS, and trust in providers. Invalidation, low provider expertise, and distrust detracted from concordance. Conclusion: These findings suggest providers can foster concordance with MUS patients by legitimizing patients' experiences, communicating knowledge about MUS, and establishing trust.

Symptom attribution and stress level in patients with medically unexplained symptoms in a Mexican emergency department

Background

Patients who come to the emergency department are different from those seen in outpatient clinics. The former suffer greater stress.

Aim

Establish an association between the attribution of the symptoms (psychosocial or organic) by the patient and the level of perceived stress in patients with Medically Unexplained Physical Symptoms (MUS) in an emergency department.

Methods

A correlational cross-sectional study was conducted in 138 patients with MUS in the emergency department of a 3rd level public hospital where the psychosocial or organic attribution of nonspecific symptom(s) by patients and the perceived stress were measured with validated scales. Bivariate analysis was performed with Chi square for categorical variables, and a Spearman correlation, p <0.05.

Results

75% of patients with psychosocial attribution have higher stress compared to patients with organic symptom attribution (25%). In Spearman's correlation, a medium but statistically significant correlation was obtained.

Conclusions

The psychosocial attribution of the patient's complaint might coexist in MUS patients with higher level of perceived stress by the patients. Health professionals might need to address both psychosocial attributions and stress in MUS patients.