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Lesnewich LM, Hyde JK, McFarlin ML, Bolton RE, Bayley PJ, Chandler HK, Helmer DA, Phillips LA, Reinhard MJ, Santos SL, Stewart RS, McAndrew LM. 'She thought the same way I that I thought:' a qualitative study of patient-provider concordance among Gulf War Veterans with Gulf War Illness. Psychol Health 2023:1-19. [PMID: 37654203 DOI: 10.1080/08870446.2023.2248481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/15/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
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.
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Affiliation(s)
- Laura M Lesnewich
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Justeen K Hyde
- Department of Medicine, Section General Internal Medicine, Boston University, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
| | | | - Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Helena K Chandler
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - L Alison Phillips
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- Department of Psychology, Iowa State University, IA, USA
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Susan L Santos
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
| | - Rachel S Stewart
- War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA
- University at Albany, State University of New York (SUNY), Albany, NY, USA
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Ramírez Aranda JM, González Sanchez MS, Hernández Guedea MA, Ordóñez Azuara YG, Treviño Uresti YK, Barahona Heredia SA. Symptom attribution and stress level in patients with medically unexplained symptoms in a Mexican emergency department. J Family Med Prim Care 2022; 11:5129-5134. [PMID: 36505573 PMCID: PMC9731031 DOI: 10.4103/jfmpc.jfmpc_2254_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- José Manuel Ramírez Aranda
- Family Medicine Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio González”, Monterrey, México,Address for correspondence: Dr. José Manuel Ramírez Aranda, Nogal #2938, Bosques del Contry, Guadalupe, Nuevo Leon C.P. 64174, México. E-mail:
| | | | - Marco Antonio Hernández Guedea
- Surgery Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio González”, Monterrey, México
| | - Yeyetsy Guadalupe Ordóñez Azuara
- Family Medicine Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio González”, Monterrey, México,Outpatient Services Clinic, Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | - Yarezzi Karolina Treviño Uresti
- Family Medicine Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio González”, Monterrey, México
| | - Samara Ailet Barahona Heredia
- Family Medicine Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio González”, Monterrey, México
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