Experiencing Bothersome Tinnitus: Evaluation of Patient Health Experiences

About This Grant

Significance to VA: Tinnitus is a common, but frequently misunderstood, chronic condition that negatively impacts function and quality of life. As of fiscal-year 2023, 2.9 million Veterans were diagnosed with tinnitus, the most prevalent service-connected disability. Tinnitus affects 10-15% of the adult population. Of this population, approximately 80% do not seek tinnitus-specific clinical services. For the remaining 20%, tinnitus impacts their lives—most commonly impairing sleep, concentration, and/or emotional reactions. Tinnitus often co-occurs with other chronic conditions, including post-traumatic stress disorder [PTSD], traumatic brain injury [TBI], anxiety, depression, and suicidal ideation. Access to rehabilitative services for bothersome tinnitus is inconsistent across VA settings. Innovation and Impact: This proposal expands the foundational work of a SPiRE pilot study (1 I2I RX004098- 01) by finalizing a patient health narrative module on bothersome tinnitus and evaluating the utility of patient narratives for clinician education. Patient narratives—stories told by patients about their health conditions and care experiences—are increasingly recognized for their ability to enhance medical consultation skills, support patient education and decision-making, and inform quality improvement initiatives. The “Database of Individual Patient Experiences” (DIPEx) is the gold standard for rendering patients’ narratives. DIPEx uses a maximum variation sampling strategy to illustrate the range and diversity of patient health experiences by including 35-50 narratives on a specific health topic. Specific Aims: This proposed project will address a critical need to improve Veterans’ access to patient- centered tinnitus care by: Aim 1: Amplify Veterans’ voices on bothersome tinnitus by conducting interviews (n=30) to expand our existing DIPEx module to reach saturation on non-biomedical themes (e.g., activity limitations and participation restrictions) known to impact patients with bothersome tinnitus. We will leverage a maximum sampling strategy to elicit diverse health experiences of Veterans living with tinnitus and use those narratives to expand our prototype DIPEx module into a full, web-based resource for those living with bothersome tinnitus and create a catalyst film for Aim 2; Aim 2: Evaluate the potential impact of integrating patient narratives into clinical education. VA clinicians (audiologists and mental health) will review a “catalyst” film developed from the patient narratives and complete an evaluation (n=50) to assess barriers and facilitators associated with the use of the catalyst film for clinician training. Catalyst films include clinically actionable content from patients’ narratives; Aim 3: Assess barriers and facilitators of the use of patient narratives for clinician education among VA operational partners (facility-level, VACO, VISN). We will conduct interviews with operational partners in audiology and mental health (n=15). Methodology: A five-phase qualitative analysis strategy will be used to analyze Aim 1 interview data. Semi- structured interviews (or Qualtrics survey) will be used to evaluate the catalyst film for use as a clinician training tool in Aim 2. Semi-structured interviews will be used to assess the barriers and facilitators on the use of patient narratives for provider training (Aim 3). A thematic qualitative analysis, using a hybrid deductive/inductive approach, guided by principles of rapid qualitative inquiry will be employed to analyze Aim 2 and 3 data. Path to Translation: This proposal involves multi-level stakeholder engagement (Veteran advisory panel members, VA clinicians and VA operational partners) to evaluate the utility of the catalyst film as a training tool for providers. Findings from Aims 2 and 3 will be presented to the VA Center for Evaluation and Implementation (CEIR) which provides individualized guidance to researchers, operations partners, managers, and policy makers to enable the scale up and spread of clinical innovations in VA settings.