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)
Objectives:
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.
Methods:
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.
Results:
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).
Implications:
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.
Impacts:
Treatment for GWI needs to consider GWV's preferences for treatment.