Serving on the homefront: the impact of deployment on National Guard spouses viewed through their strengths, supports, and stories

Since September 11, 2001 the United States has entered a period of increased military action. Over 2.5 million service members have been deployed to the Middle East, with the National Guard playing an increasingly large role in the military interventions. The spouses of these men and women had to learn to navigate lengthy combat deployments. The purpose of this study is to understand the experience of deployment from the perspective of a National Guard spouse. This study uses qualitative methods to explore how they construct their realities about this time. We focus on the meaning-making of these experiences and use the strengths perspective as a framework for the study. Nine National Guard spouses were interviewed. All were partnered during at least one deployment. Semi-structured interviews focused on their essential deployment narratives: the challenges they faced and strengths and support systems they utilized. Quantitative measures were used to reinforce these findings. Data was analyzed for common themes and coded. The narratives revealed the external difficulties they experienced throughout the deployment cycle. Major themes included external and internal challenges and fear of death of the National Guard member. Personal strengths and external supports were explored for their benefit during deployment events. Independence and resilience were found to allow these women to navigate periods of separation. However, additional traits, such as stubbornness and the reluctance to seek help, may have made deployments more difficult. Helpful support networks included their deployed spouse, and children. Friends and extended family varied in terms of supportiveness. Systems like the National Guard Family services also varied in helpfulness during this time and tended to be seen as less effective. Specifically, Family Readiness Groups were largely seen as unhelpful. Suggestions to improve the deployment experience were gathered. Common themes focused on methods to facilitate connections to people, information, and resources. The findings of this study are important in that there is very little empirical data and no outcome studies on National Guard spouses, especially from this most current war. These results have the ability to better inform civilian and military systems about how to provide services and support to this group of military spouses and families. Implications for policy and practice are discussed

How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

Background: In this paper, we report the findings of a realist synthesis that aimed to understand how and in what circumstances patient reported outcome measures (PROMs) support patient-clinician communication and subsequent care processes and outcomes in clinical care. We tested two overarching programme theories: (1) PROMs completion prompts a process of self-reflection and supports patients to raise issues with clinicians and (2) PROMs scores raise clinicians’ awareness of patients’ problems and prompts discussion and action. We examined how the structure of the PROM and care context shaped the ways in which PROMs support clinician-patient communication and subsequent care processes. Results: PROMs completion prompts patients to reflect on their health and gives them permission to raise issues with clinicians. However, clinicians found standardised PROMs completion during patient assessments sometimes constrained rather than supported communication. In response, clinicians adapted their use of PROMs to render them compatible with the ongoing management of patient relationships. Individualised PROMs supported dialogue by enabling the patient to tell their story. In oncology, PROMs completion outside of the consultation enabled clinicians to identify problematic symptoms when the PROM acted as a substitute rather than addition to the clinical encounter and when the PROM focused on symptoms and side effects, rather than health related quality of life (HRQoL). Patients did not always feel it was appropriate to discuss emotional, functional or HRQoL issues with doctors and doctors did not perceive this was within their remit. Conclusions: This paper makes two important contributions to the literature. First, our findings show that PROMs completion is not a neutral act of information retrieval but can change how patients think about their condition. Second, our findings reveal that the ways in which clinicians use PROMs is shaped by their relationships with patients and professional roles and boundaries. Future research should examine how PROMs completion and feedback shapes and is influenced by the process of building relationships with patients, rather than just their impact on information exchange and decision making