Gulf War Veterans (GWVs) with Chronic Multisymptom Illness (CMI) experience levels of disability as severe as other major medical illnesses. Beliefs about their condition (illness perceptions) account for 33% of variability in disability levels among GWVs with CMI's, and may be the most important determinant of health outcomes. This is because patients use their illness perceptions (e.g., "my CMI is improved by staying active") to guide their management (e.g., increase physical activity). What is not known is how providers should address illness perceptions. Previously attempted interventions to change GWVs with CMI's "maladaptive" illness perceptions have generally suffered from poor adherence or low efficacy. An alternative approach is to acknowledge that while providers are experts in medical science, patients are experts in their health experience. Both sets of expertise are needed to improve the care for the individual. Thus, GWVs with CMI and their providers need to develop aligned or concordant illness perceptions. This approach is consistent with the approach used at the VA's War Related Illness and Injury Study Center (WRIISC), a specialized clinic for deployed Veterans with CMI. Over 97% of Veterans seen at the WRIISC are satisfied with their care. We need to know if concordant illness perceptions explain this high satisfaction rate and ultimately improve adherence to recommendations for future healthcare utilization, self-management, and lower disability.
AIM 1: Determine the relationship between degree of concordance in illness perceptions between providers and GWVs with CMI and outcomes over time.
H1: Encounters where there is a greater degree of concordance in illness perceptions (assessed through an observer rating system) will result in GWVs with CMI reporting better outcomes (greater satisfaction, greater adherence to provider recommendations for utilization, greater adherence to provider recommendations for self-management, and reduced disability) one week, three months and one year after the encounter.
H2: GWVs with CMI who perceive greater concordance in illness perceptions (assessed immediately after the encounter by the Illness Concordance Scale) will report better health outcomes (defined in H1) one week, three months and one year after the encounter.
AIM 2: Compare the impact of concordance in illness perceptions on health-related outcomes in WRIISC vs. PCP encounters.
H3: WRIISC providers will spend a greater proportion of their encounters eliciting and addressing illness perceptions (assessed through an observer rating system) than VHA PCPs.
H4: Patients seen at the WRIISC will perceive more concordant illness perceptions and better health outcomes (defined in H1) one week, three months and one year after the encounter than patients seen by a PCP only.
AIM 3: Use qualitative analysis of interviews with GWVs with CMI and qualitative analysis of patient-provider encounters to identify the communication practices and other factors that contribute to concordance in illness perceptions.
We will conduct an observational prospective study to examine the relationship between degree of concordance in illness perceptions between GWVs with CMI and providers and health outcomes. We will audio record the clinical encounters of 100 GWVs with CMI seen at the WRIISCs, and 100 GWVs with CMI seen by VHA Primary Care Physicians. We will measure patients' perceived concordance of illness perceptions with an observer rating system and by using the Illness Concordance Questionnaire. Health outcomes will be measured one week, three months and one year after the encounter. We will conduct qualitative interviews with 30 of the GWVs with CMI.
No results yet
If concordant illness perceptions are prospectively associated with improved health outcomes for GWVs with CMI, the ability to achieve concordant illness perceptions could be targeted as an important competency of providers.
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