As many as 20 percent of the U.S. military veterans who served in Iraq and Afghanistan and up to 30 percent of those who fought in the Vietnam War will suffer from Post-Traumatic Stress Disorder (PTSD) in a given year, according to the U.S. Department of Veteran’s Affairs. This is far above the national average of the 7.8 percent of adult Americans who develop non-combat related PTSD at some point in their lifetimes.
Such a sizable veteran population facing such a severe illness presents clinical researchers, drug, device and medical therapy developers with the opportunity to help make a difference. However, combat related PTSD in military veterans also presents distinctive challenges.
PTSD populations are not one size fits all. Numerous subtleties must be considered when engaging, recruiting and retaining military veterans for clinical research trials regarding their PTSD and potential treatments.
Here are seven ways to successfully work with military vets in PTSD clinical trials:
- You must know the military population well – really know it. You cannot pretend you know it. Authenticity is key to vets. If it’s not there, they will walk. Take the time to learn about the military culture and respect it.
- Military veterans live their life based on rules, organization, punctuality (“if you are on time, you are late!”) and respecting each other. Be consistent and organized. Don’t make a veteran wait for their appointment and show respect at all times.
- Each veteran will have a different experience based on when they served and in which branch they served. Know the difference between different conflicts – WWII, Korea, Vietnam, Desert Storm, Iraq, and Afghanistan; the branches of service; what they may have faced in a specific conflict; the environment they returned home to (what was the state of the country) and what specific support they may require to remain in a clinical trial as a result.
- Remember older veterans are not as tech savvy as younger ones. Be patient and be ready to provide a variety of engagement support to veterans from different eras in any trial.
- Avoid condition triggering in veterans with PTSD by making sure the clinical trial sites are as safe and comfortable for them as possible. If a site is cold or seems unsafe (crowded, lots of kids or patients wandering around) they may just leave the trial.
- Don’t forget about female military veterans. There are more than two million female military veterans, roughly 10 percent of the U.S. military veteran population. Despite the higher prevalence of combat related PTSD among men, lifetime non-combat related PTSD occurs at about twice the rate among women as it does in men. The types of combat related index traumas may differ in female veterans compared to male veterans and should be considered when interacting with them. Consider having both a male and female intake staff available when speaking to a potential subject to allow for gender specific intake discussion. If a site has a veteran on staff, it would also be best to consider allowing the veteran to speak to potential subjects to establish a common relationship.
- Understand the reasons behind the veteran participating in the clinical trial versus receiving care through the U.S. Department of Veteran’s Affairs (VA) health system. Some veterans may be seeking a quick evaluation with or without treatment and see a clinical trial as a faster method than through the VA. Be cognizant of this when screening the subject. Ensure the expectations of their participation are clear. When explaining the trial, keep in mind that most veterans mistrust medicine and medical care. They may have experienced bad care through the VA or medical treatment while on active duty and may not be a good fit for a clinical trial setting as a result.