Challenges of research on women veterans with traumatic stress disorders.

Authors: Julie Weitlauf, PhD1, 2, 4 wjulie1@stanford. edu, Susan M. Frayne, MD, MPH. FACP.1, 2, 4, Tina Lee, MD, MSC2, 3, Josef Ruzek, PhD1, 3 John Finney, PhD1 & Ann Thrailkill, RNP2 [1VA Palo Alto Health Care System, Center for Health Care Evaluation, 2VA Palo Alto Health Care System, Women’s Health Center; 3National Center for PTSD, Education Division; 4Stanford University School of Medicine.] Goal. To assess traumatic reactions to preventive gynecological examinations (cervical cancer surveillance, CCS, or Pap smear examinations) among women veterans with and without histories of sexual trauma and resultant posttraumatic stress disorder (PTSD). We hypothesize that mental health factors such as presence of PTSD and history of sexual trauma may impact the preventive gynecological (GYN) care given to women veterans. Specifically, we anticipate that sexual trauma and PTSD may predispose women to more significant experiences of pain and emotional distress experienced during these exams. In turn, this may impact providers’ attitudes, expectations for, and care of this population of women. We hope that the results of the present study will help us develop interventions to improve receipt of regular gynecological care for these vulnerable populations. Ethical and scientific justification. A major challenge to contemporary clinical scientists is the appropriate and ethical conduct of trauma focused research (Draucker, 1999; Newman, Walker, & Gefland, 1999; Ruzek & Zatzick, 2000; Thewes, Fitzgerald, & Sulmasy, 1996). At a minimum, participation in research should not subject individuals to harm. Indeed, clinical researchers must balance the needs of science with its potential risks. Ideally, clinical research will not only advance knowledge and practice, but may also provide trauma survivors cathartic benefit from sharing “their story.” One area of particular concern for trauma researchers is the magnitude and clinical significance of emotional distress that may accompany participation when patients recall or discuss personal details of a traumatic event. Understanding typical perceptions of the risks and benefits associated with trauma research is critical to the ethical and effective conduct of such work. This entails understanding the nature of participatory distress, the contexts in which it occurs, its’ influence on more general perceptions about research, and its association with other potential risks. Some clinical scientists have begun to descriptively document the typical experiences of participants in 54 Cases J R020108 4/3/07 2:50 PM Page 54