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

Laura M Lesnewich; Justeen K Hyde; Mikhaela L McFarlin; Rendelle E Bolton; Peter J Bayley; Helena K Chandler; Drew A Helmer; L Alison Phillips; Matthew J Reinhard; Susan L Santos; Rachel S Stewart; Lisa M McAndrew

doi:10.1080/08870446.2023.2248481

'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 Sep 1:1-19. doi: 10.1080/08870446.2023.2248481. Online ahead of print.

Authors

Laura M Lesnewich¹, Justeen K Hyde^{2

3}, Mikhaela L McFarlin⁴, Rendelle E Bolton^{3

5}, Peter J Bayley^{6

7}, Helena K Chandler¹, Drew A Helmer^{8

9}, L Alison Phillips^{1

10}, Matthew J Reinhard¹¹, Susan L Santos¹, Rachel S Stewart¹¹, Lisa M McAndrew^{1

4}

Affiliations

¹ War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System, East Orange, NJ, USA.
² Department of Medicine, Section General Internal Medicine, Boston University, Boston, MA, USA.
³ Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, USA.
⁴ University at Albany, State University of New York (SUNY), Albany, NY, USA.
⁵ The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
⁶ War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA.
⁷ Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁸ Center for Innovations in Quality, Effectiveness & Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
⁹ Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
¹⁰ Department of Psychology, Iowa State University, IA, USA.
¹¹ War Related Illness and Injury Study Center (WRIISC), Washington DC Veterans Affairs Medical Center, Washington, DC, USA high-quality.

PMID: 37654203
DOI: 10.1080/08870446.2023.2248481

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.

Keywords: Medically unexplained symptoms; chronic multisymptom illness; goal concordant care; patient-provider communication; persistent physical symptoms; somatization.