Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care.

Weber MC, Jendro AM, Fischer EP, Drummond KL, Haltom TM, Hundt NE, Cucciare MA, Pyne JM. Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care. Medical care. 2024 Dec 1; 62(12 Suppl 1):S84-S90.

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Abstract:

BACKGROUND: Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care. OBJECTIVES: To explore veterans' experiences and preferences for aligning measurement-based PTSD care with their own treatment goals. METHOD: Qualitative interviews were conducted with veterans (n = 15) with PTSD who had received at least 2 sessions of a TF-EBP. MEASURES: Survey on the administration of outcomes questionnaires and demographics and an interview about their most recent TF-EBP episode. RESULTS: Half of veterans had symptom-focused goals and half did not; all had at least one treatment goal that was not symptom-focused. They typically met their goals about functioning and coping skills but not their symptom reduction goals. We found veterans overall were receptive to MBC but preferred patient-reported outcomes measures about functioning, wellbeing, coping skills, and understanding their trauma more than the commonly used PTSD symptom scale (the PCL-5). CONCLUSIONS: Many veterans in this sample disliked the PCL-5 because it reinforced their maladaptive cognitions. Such veterans might be more receptive to MBC if offered patient-report outcomes measures that better align with their functional and wellbeing goals. For many goal/outcome areas, psychometrically sound measures exist and require better implementation in PTSD care. For some areas, scale development is needed.