Lead/Presenter: Lisa McAndrew, WRIISC
All Authors: McAndrew LM (War Related Illness and Injury Study Center), Quigley, K.S. (Center for Healthcare Organization & Implementation Research), Pigeon, W. (VA Center for Excellence in Suicide Prevention) Lu, S-E. (Rutgers University) Rath, J. (New York University School of Medicine) Litke, D.R. (War Related Illness and Injury Study Center) Helmer, D.A. (War Related Illness and Injury Study Center)
Gulf War Veterans (GWVs) engagement in treatment for Gulf War Illness (GWI) is poor. Our data show 78% of GWVs are NOT very satisfied with the care they receive and the largest clinical trial found that less than 40% were adherent to treatment. To address this quality chasm, the VA invested in the second largest clinical trial for GWI to test if a treatment based on GWVs preferences, to reduce their cognitive dysfunction, could address GWVs needs. The trial compared a cognitive rehabilitation treatment, problem-solving treatment, to a health education control. Our aim is to determine if problem-solving treatment resulted in greater adherence, satisfaction and a better relationship with the provider as compared to health education.
This multi-site clinical trial recruited 268 GWVs with GWI from three VA sites. GWVs were randomized to receive 12 weeks of problem-solving treatment (PST) or 12 weeks of a health education control. All treatments were delivered over the phone by clinicians from one VA. GWVs were assessed at baseline, 4 weeks, 12 weeks (primary end-point) and 6 months. We compared adherence to treatment, satisfaction with treatment, and Veteran's perceived relationship with their study provider across arms.
GWVs attended an average (SD) of 10.67 (3.33) sessions of PST and 11.06 (2.03) sessions of health coaching (p = .32). Among those who started the treatment, 89% attended 12 sessions of PST and 93% attended 12 sessions of health coaching (p = ns). There were no differences in level of satisfaction between PST (mean (SD) = 16.40 (2.18)) and health coaching, (mean (SD) = 16.59 (2.21), p = ns.) There were no differences in level of perceived quality of their relationship with their study provider between PST (mean (SD) = 24.36 (3.30) and health coaching (mean (SD) = 24.38 (4.34), p = ns).
GWVs with GWI are similarly adherent to and satisfied with a patient-centered behavioral treatment that addresses their neurocognitive symptoms as with a behavioral treatment that teaches them lifestyle changes (e.g., diet) to improve their physical symptoms. Notably, over 85% of GWVs were adherent and satisfied to either treatment. This is important because GWVs with GWI have well-documented mistrust and poor satisfaction with existing VA care.
Treatment for GWI needs to consider GWV's preferences for treatment.