Johnson Nicole L, Van Tiem Jennifer, Steffensmeier Kenda Stewart, Akuley Suzanne, Ball Daniel, Thomas Emily B K, Mengeling Michelle, Norman Sonya, Pratt Alessandra A, Driscoll Mary A, Garvin Lauren A, Hart Kimberly J, Hadlandsmyth Katherine
Center for Access & Delivery Research and Evaluation (CADRE), Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA, USA.
Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA, USA.
J Gen Intern Med. 2025 May 13. doi: 10.1007/s11606-025-09588-2.
Patients with co-occurring chronic pain and PTSD are especially vulnerable to debilitating symptoms and frustrating experiences seeking healthcare. The complicated nature of the health conditions and their treatments present a challenge for providers to communicate their treatment recommendations and rationale.
This qualitative study explored Veterans' views on communication with their providers during clinical visits related to their chronic pain and PTSD treatments, so that we may understand their experiences and identify opportunities to improve clinical communication and patient satisfaction.
Semi-structured interviews with the interview guide finalized based on feedback from a Veteran engagement panel.
Veterans diagnosed with chronic pain and PTSD who receive care from Veterans Health Administration.
Inductive thematic analysis to characterize how Veterans describe interactions with providers treating their chronic pain and PTSD.
Providers' communication influences Veterans' perceptions in three ways: (a) when Veterans expressed satisfaction with their provider, they described their gratitude for learning about their options; (b) when Veterans expressed dissatisfaction, it often represented a lack of mutual understanding or knowledge of the provider's rationale; and (c) inaccurate information on electronic medical records perpetuated a distrustful environment.
Breakdowns occur when Veterans are unsure of their providers' rationale and our data underscore the importance of clear communication in establishing trust and optimizing care for Veterans with PTSD and chronic pain. As the interplay between chronic pain and PTSD symptoms takes centerstage in clinical innovations, providers must consider how best to educate their patients and explain their rationale for recommendations. Trauma-informed strategies may be especially valuable for delivering care to an inordinately vulnerable population.
同时患有慢性疼痛和创伤后应激障碍（PTSD）的患者特别容易出现使人衰弱的症状，并且在寻求医疗保健时会经历令人沮丧的事情。健康状况及其治疗的复杂性给医护人员传达治疗建议及其依据带来了挑战。
这项定性研究探讨了退伍军人在与医护人员进行与慢性疼痛和PTSD治疗相关的临床就诊时对沟通的看法，以便我们了解他们的经历，并确定改善临床沟通和患者满意度的机会。
采用半结构化访谈，访谈指南根据退伍军人参与小组的反馈最终确定。
从退伍军人健康管理局接受治疗的被诊断患有慢性疼痛和PTSD的退伍军人。
采用归纳主题分析法来描述退伍军人如何描述与治疗其慢性疼痛和PTSD的医护人员的互动。
医护人员的沟通通过三种方式影响退伍军人的认知：（a）当退伍军人对其医护人员表示满意时，他们对了解到的选择表示感激；（b）当退伍军人表示不满时，这通常表示缺乏相互理解或对医护人员的理由缺乏了解；（c）电子病历上的不准确信息使不信任的环境持续存在。
当退伍军人不确定其医护人员的理由时就会出现沟通障碍，我们的数据强调了清晰沟通在建立信任和优化对患有PTSD和慢性疼痛的退伍军人的护理方面的重要性。由于慢性疼痛和PTSD症状之间的相互作用在临床创新中占据中心地位，医护人员必须考虑如何最好地教育患者并解释其建议的理由。了解创伤的策略对于为极度脆弱的人群提供护理可能特别有价值。
