title: Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication.
abstract: OBJECTIVE
  Medically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans' MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement.
  
  
  METHODS
  Veterans experiencing MUS (n=204) reported on their primary care providers' communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement.
  
  
  RESULTS
  Veterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients' illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction.
  
  
  CONCLUSIONS
  Providers' interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.
authors.affiliation: Department of Psychology, Iowa State University, Ames, USA; War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Healthcare System, East Orange, USA. Electronic address: alisonp@iastate.edu.
authors.forename: L Alison
authors.initials: LA
authors.lastname: Phillips
authors.affiliation: War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Healthcare System, East Orange, USA; Department of Educational and Counseling Psychology, University at Albany, Albany, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: McAndrew
authors.affiliation: Department of Psychology, The George Washington University, Washington, D.C., USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Laman-Maharg
authors.affiliation: War Related and Injury Study Center, US Department of Veterans Affairs, Washington, D.C., USA; Silberman School of Social Work, Hunter College, CUNY, NY, USA.
authors.forename: Katharine
authors.initials: K
authors.lastname: Bloeser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D014728:Veterans
keywords: Doctor-patient communication; Illness and treatment representations; Medically unexplained symptoms; Primary care; Treatment adherence; Veterans