Implementing and Evaluating a Patient-Centered PTSD Treatment Program for Military Personnel
Aim
Conduct a partially randomized preference trial to evaluate the relationships between patient characteristics, preferences, treatment engagement, and outcomes for military members who engage in a shared-decision-making pre-intervention followed by evidence-based treatment. Also evaluate the impact of shared decision making on PTSD treatment completion and symptom reduction.
The past 20 years of research, including by STRONG STAR, has yielded sufficient evidence for the efficacy of several therapies for posttraumatic stress disorder in military personnel. Similarly, success with different delivery formats – spread out over several weeks, condensed into one or two weeks, in-office, in-home, or via telehealth – has made evidence-based treatments more appealing and accessible to the military community.
Yet PTSD recovery rates are still not as high in military as compared to civilian populations, and there seems to be a reluctance among military personnel first to initiate and then to complete PTSD treatment. Some report that’s due to feeling like a particular treatment is not well-suited to them or their situation, while others have expressed frustration over a seeming lack of control over their treatment.
Empower patients, improve care?
If service members seeking PTSD treatment could be presented with more options and allowed to engage in informed, shared decision making about the treatment they receive, might that increase their likelihood of initiating, more fully engaging in, and completing treatment – and in the process lead to improved recovery rates and increased patient satisfaction?
Answering that question is the aim of a STRONG STAR study led by Initiating Principal Investigator (PI) Alan Peterson, PhD (Lt Col, USAF, Ret.), and Early Career Partnering PI Vanessa Jacoby, PhD, of The University of Texas Health Science Center at San Antonio.
How the study works
The study will involve active duty military personnel at Fort Cavazos and evaluate a shared-decision-making model of patient-centered healthcare that has been shown to maximize patient engagement and satisfaction. Military participants will be offered and receive thorough descriptions of a menu of evidence-based, cognitive-behavioral therapies to include Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Written Exposure Therapy (WET). Options also will be provided on treatment frequency (condensed or spread out over several weeks), treatment modality (in the clinic or via telehealth), and length (number of sessions may vary by treatment type and/or patient response).
This two-step, partially randomized preference trial will then follow a process that allows patients with a strong preference to select their particular treatment and others to identify treatment arms to which they are willing to be randomized. Investigators will examine which patient characteristics and preferences lead to selection of and improved outcomes with different treatment options, with the goal of guiding future efforts in personalized medicine.
Expected benefit
Investigators also will compare these outcomes to prior randomized clinical trials with military personnel that did not involve shared decision making. They hypothesize that those who engage in shared decision making will (1) show higher rates of treatment completion and (2) have larger reductions in PTSD symptoms posttreatment.
If their hypotheses are correct, this model could be recommended to help improve PTSD care across the Military Health System for service members with a PTSD diagnosis who avoid treatment or who drop out prematurely.