Center for Integrated Healthcare, VA Western New York Healthcare System-Buffalo.
Department of Family Medicine, State University of New York/University-Buffalo.
Rehabil Psychol. 2018 Feb;63(1):121-130. doi: 10.1037/rep0000165.
PURPOSE/OBJECTIVE: Explore cognitive, affective, and experiential factors that inform veterans' traumatic brain injury (TBI)-related beliefs. Research Method/Design: Qualitative descriptive study of 22 veterans who received care for TBI at a VA Medical Center in the Northeastern United States using directed content analysis. Measures included a semistructured interview, demographic survey, the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist (PCL), Neurobehavioral Symptom Inventory (NSI), and Insomnia Severity Index (ISI).
Results were organized according to Leventhal et al.'s (1997) illness perception model, including veterans' self-reports regarding: (a) knowledge of TBI, labels, and symptoms (identity); (b) etiology (cause); (c) the biopsychosocial impact of TBI (consequences); (d) symptom chronicity (timeline); and (e) recovery expectancy and management strategies (controllability). Participants identified common causes of TBI, as well as acute symptoms. Uncertainty was present with regard to TBI nomenclature, recovery expectancies and trajectories, and the impact of co-occurring mental health diagnoses.
CONCLUSIONS/IMPLICATIONS: Opportunity exists to improve TBI-related education in the course of routine, patient-centered care. Clinicians should take into account the subjective beliefs and experiences, including co-occurring mental health conditions, that inform patients' illness representations to improve patient-provider communication and the quality of TBI care. (PsycINFO Database Record
目的/目标：探索影响退伍军人创伤性脑损伤（TBI）相关信念的认知、情感和体验因素。
研究方法/设计：对 22 名在美国东北部退伍军人事务部医疗中心接受 TBI 治疗的退伍军人进行定性描述性研究，采用定向内容分析。措施包括半结构化访谈、人口统计学调查、酒精使用障碍识别测试-消费项目（AUDIT-C）、患者健康问卷-9（PHQ-9）、创伤后应激障碍检查表（PCL）、神经行为症状量表（NSI）和失眠严重程度指数（ISI）。
结果按照 Leventhal 等人（1997）的疾病感知模型进行组织，包括退伍军人关于以下方面的自我报告：（a）TBI 的知识、标签和症状（身份）；（b）病因（原因）；（c）TBI 的生物心理社会影响（后果）；（d）症状的持续性（时间线）；以及（e）恢复期望和管理策略（可控性）。参与者确定了 TBI 的常见原因以及急性症状。TBI 命名法、恢复预期和轨迹以及同时发生的心理健康诊断的影响存在不确定性。
结论/意义：在常规的以患者为中心的护理过程中，有机会改善与 TBI 相关的教育。临床医生应考虑到影响患者疾病表现的主观信念和经验，包括同时发生的心理健康状况，以改善患者与提供者之间的沟通和 TBI 护理质量。
