Discussion
unexplained syndrome, arthritis, pain
CHRONIC PAIN, CHRONIC ILLNESSES, ARTHRITIS
This study aimed to identify the commonly reported treatment and life goals for veterans receiving treatment for Gulf War Illness, a highly disabling medically unexplained syndrome. We found that treatment goals among this population fell into the following four themes: 1) Get better/healthier, 2) Improve quality of life, 3) Obtain validation of GWI symptoms, and 4) Don’t know/Don’t have any. We found that life goals among this population fell into the following six themes: 1) Live a fulfilling life, 2) Live a happy life, 3) Live a healthy life, 4) Be productive/financially successful, 5) Manage GWI, and 6) Don’t know/Don’t have any.Treatment goals were largely focused on getting better/healthier (e.g., improving GWI symptoms, learning to cope with symptoms, preventing symptom progression), with 67.6% of participants endorsing at least one treatment goal to get better/healthier. These findings are largely consistent with previous research examining treatment goals among patients with chronic medical conditions, especially in a treatment-seeking sample such as this one. Similar to our sample, research has shown that treatment goals among individuals with chronic pain, arthritis, and other chronic illnesses are focused on improving physical symptoms such as pain intensity and improving functional status [Life goals among veterans with GWI were predominantly focused on living a fulfilling life. Over half of participants reported at least one life goal related to living a fulfilling life focused on connecting to others, helping others, and finding meaning and spiritual fulfillment. Furthermore, 34.6% of participants reported at least one life goal related to enjoying life. Our findings provide a guide that may be helpful to providers when exploring goals with veterans with GWI. While each veteran’s unique goals should be assessed, these themes could be helpful for providers to keep in mind as potential areas to explore.It is also important to note that about one fourth of veterans in our sample endorsed treatment goals related to receiving validation of their GWI symptoms. Veterans reported a desire to obtain validation from their providers that their symptoms are real, and to better understand their symptoms. This finding is not surprising considering previous literature that patients with MUS often report feeling dismissed by healthcare providers [Assessing both treatment and life goals of veterans with GWI is important because doing so may aid in improving patient-provider concordance around GWI management, strengthen veteran-provider relationships, and identify patient-centered treatment objectives. While this study highlights common treatment and life goals for veterans with GWI, future research is needed to establish how to best incorporate both kinds of goals into care. One model that is already widely used within the Veteran’s Health Administration is the VA’s Whole Health Program. In this model, treatment and life goals are assessed, and treatment goals are framed as a means to ultimately achieve life goals. For example, a veteran who is presenting to treatment with a desire to reduce pain may be motivated to engage in treatment to achieve an overarching life goal of being an active and engaged father to his children. Thus, the Whole Health model may be a helpful framework to consider incorporating into the care of veterans with GWI. Our new goal typology can facilitate future research on models of care and allow for cross-study comparison of patient-generated goals among those with GWI.There are some limitations to the current study. First, the sample was mainly comprised of white, male veterans who use the Veterans Health Administration. Our focus on goals in veterans with GWI addressed a gap in the literature; however, absent other evidence, these results should not be generalized beyond this group. Second, the use of a single question to assess treatment goals and a single question to assess life goals is a limitation. For example, we were unable to assess whether the participants understood the distinction between the questions delineating treatment and life goals or assess any relationship between these two categories of goals.In sum, this study contributes new knowledge by identifying the common treatment and life goals among veterans with GWI. The findings revealed that veterans with GWI identify treatment goals related to getting better/improving GWI, improving quality of life, and receiving validation of their symptoms, and the large majority of veterans identify life goals related to living a fulfilling, productive, and happy life. Explicitly assessing veterans’ treatment and life goals and working towards a shared treatment goal that incorporates veteran’s overarching life goals may be beneficial to incorporate into routine clinical practice. Doing so could help promote patient-provider concordance around the course of treatment for Gulf War Illness and support a more person-centered approach to care.