Patient Health Experiences: Using Patient Narratives to Improve Tinnitus Rehabilitation Services and Outcomes

NIH RePORTER · VA · I21 · · view on reporter.nih.gov ↗

Abstract

Tinnitus, a chronic condition for which there is no “cure,” is the most common service-connected disability at the Department of Veterans Affairs1. The functional effects of chronic tinnitus can vary widely, ranging from being a mild nuisance to being completely disabling.2 Veterans who are negatively impacted by tinnitus commonly report sleep disturbance, difficulty concentrating, and disruptive emotional reactions2. In addition, Veterans with tinnitus also suffer from multiple comorbidities, including depression, anxiety, sleep disorders, post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and suicidal ideation3-5. Although some Veterans with tinnitus spontaneously develop their own unique coping strategies to reduce the impact of tinnitus on their lives, others need a lot of support to improve quality of life and functional status, especially in the context of other physical or mental health comorbidities. In our program of research on tinnitus among Veterans6,7, we have found that there are inconsistent standards of tinnitus care in VA settings8. Cognitive Behavioral Therapy (CBT) has been shown to improve quality of life and functional status with tinnitus9, however, many VA health care providers report being unaware that the method can be used to assist people negatively impacted by tinnitus7. In contrast to the relative difficulty finding providers who are knowledgeable about effective, evidence-based care for tinnitus, patients find easy access to products (supplements, ear drops, untested devices, etc.) that falsely promise a cure and are directly marketed, often via the internet, to people struggling with tinnitus. Trying multiple over- the-counter products in hopes of finding a cure that does not exist often exacerbates anxiety and frustration in Veterans with tinnitus, a vulnerable population already burdened with managing multiple co-morbid behavioral health conditions. Past interviews with individuals with hearing loss and tinnitus has shown that peer testimonials are important factors in Veterans' sense of hope about their future and in their willingness seeking help for these conditions10. Thus, Veterans' stories about their challenges, decision-making processes, experiences with seeking a cure, and experiences with trying various coping strategies in spite of the lack of a cure could be leveraged as an invaluable source of wisdom, information, and support for their peers with bothersome tinnitus who are struggling and seeking answers that are hard to find. The gold standard of rendering patient narratives on health conditions is called the “The Database of Individual Patients' Experience” (DIPEx). DIPEx is rigorous, evidence-based methodology for eliciting rich information on the health experiences of a broad range of patients with diverse chronic health conditions. The specific aims of this mixed-method are to: (1) Use DIPEx methodology to document Veterans' experiences (n= 10-15) with bothersome tinnitus and ...

Key facts

NIH application ID
10486422
Project number
1I21RX004098-01
Recipient
PORTLAND VA MEDICAL CENTER
Principal Investigator
KHAYA Delaine CLARK
Activity code
I21
Funding institute
VA
Fiscal year
2022
Award amount
Award type
1
Project period
2022-06-01 → 2024-05-31