Military Veterans Knowledge, Attitudes, and Interest in VCA Treatment for Disfiguring Service-Related Injuries: Developing Shared Decision-Making for VCA
Abstract
The ongoing conflicts in Iraq, Afghanistan, and other locales leave thousands of Service men and women with devastating bodily injuries annually. From 2003 to 2011, over 7,000 American Soldiers suffered traumatic injury to the head and neck. Of those sustaining injuries to the upper or lower extremities, 28.7% experienced injury to the wrist, hand, and finger, and 30% experienced injury to the face. Civilians also sustain catastrophic bodily injuries. Of the 861,888 injuries reported in 2015, 532,001 (61.7%) were classed as serious to nonsurvivable, with 18% occurring to the head, 16.2% to the upper extremity, 2.7% to the lower extremity, and 0.9% to the head or neck. Advances in reconstructive surgery and other areas of medical care have increased the rates of survival from such injuries, but often leave the survivors with severe disfigurement, functional limitations, and reduced quality of life. Vascularized composite allotransplantation (VCA) holds substantial promise to improve the functioning, mobility, and quality of life for catastrophically injured Service men and women and Veterans, particularly patients for whom currently available reconstructive procedures or prosthetics have not helped. To date, a total of 72 VCA transplants have been performed. The number of Veterans receiving VCAs among the thousands severely injured in recent and ongoing conflicts is currently unknown, but likely represent only a small fraction of that figure. The extent to which this reflects limited awareness of this treatment option, injured Veterans’ disinterest in receipt of VCA, and/or providers’ misperceptions of the appropriateness of VCA for their patients is currently unknown. The overarching goal of the proposed research is to understand the potential demand for VCA and to develop an evidence base to assist in the development of a shared decision-making process that will help this vulnerable group of military Veterans, along with their family caregivers, make authentic treatment decisions and optimize the results of VCA by assuring adherence with graft care. To examine the experiences of Veterans and their family caregivers regarding their interest in VCA as a possible treatment, we will interview 60 Veterans with catastrophic injuries and their caregivers. We will also interview the healthcare provider identified by the Veteran as the provider that is most important in treating his or her Service-related injuries. We will also convene a Delphi panel of experts to develop a proposal for a shared decision-making process to aid Veterans, their caregivers, and healthcare providers in making informed decisions about pursuing VCA. The results of the study will be widely distributed to all stakeholders. The proposed research addresses a priority area of the Department of Defense FY18 Reconstructive Transplant Qualitative Research Award in that it will identify “Factors impacting a patient’s decision to pursue VCA” and will create a new knowledge base about catastrophically injured Veterans’, their family caregivers’, and their healthcare providers’ knowledge, attitudes, and the acceptability of and interest in VCA.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910274
Entities
People
- Laura Siminoff
Organizations
- Temple University
- United States Army