(PS10-51) She Thought the Same Way I That I thought: A Qualitative Study of Patient-provider Concordance Among Veterans with Gulf War Illness

Chronic multisymptom illnesses (CMI), such as chronic fatigue syndrome, irritable bowel syndrome, and Gulf War Illness (GWI), are prevalent in healthcare settings and 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 CMI. This qualitative study focuses on the experiences of United States military Veterans living with GWI, who have endured unique healthcare challenges. GWI is a specific form of CMI characterized by chronic pain, fatigue, and neurocognitive difficulties that afflicts about 30% of military Veterans who deployed to the 1990-1991 Gulf War theatre. Qualitative interviews were conducted with 31 Veterans with GWI to explore factors that contributed to and detracted from concordance with their Veteran Affairs (VA) healthcare providers. Participants met the Kansas criteria for GWI and denied medical diagnoses that could better account for GWI symptoms (e.g., cancer). In addition to being seen by VA primary care, over half of participants also sought consultation at a War Related Illness and Injury Study Center, a tertiary care center that 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. Major themes associated with patient-provider concordance included validation of illness experiences, perceived provider expertise in GWI/CMI, and trust in providers. Within the broader theme of provider expertise, provision of treatment recommendations emerged as a sub-theme that captured the importance of clear and collaborative patient-provider communication. Invalidation, low provider expertise, and distrust detracted from concordance. These findings suggest providers can foster concordance with CMI patients by legitimizing patients’ experiences, communicating knowledge about CMI, offering specific recommendations, and establishing trust. These findings also suggest clinical psychologists, who have expertise in validation and building trust, are particularly well-suited to contribute to GWI/CMI care. This aligns with the VA/Department of Defense (DoD) Clinical Practice Guidelines for the Management of CMI, which includes cognitive behavioral therapy and mindfulness-based interventions as first-line treatments for these conditions.