Exploring how military culture shapes veterans’ perception of aortic aneurysm repair: A qualitative study

Abstract

Background

Veterans represent a distinct cultural group whose perceptions of illness and treatment are influenced by military culture. The study explores how prior military service shapes Veterans’ assumptions and behaviors in the setting of aneurysm repair surgery.

Study Design

We conducted content and thematic analysis of a case series of 10 transcripts from telephone interviews with older (76.7 ± 4.3 years) African American and White male Veterans now residing in the Southern U.S. who underwent open or endovascular aneurysm surgery at Veterans Affairs Medical Centers or university affiliates between 2004 and2019.

Results

Throughout the continuum of care, Veterans described deferring to authority and not questioning provider’s decisions [“I just can’t make a judgment on that, because I’m not a doctor”]. Veterans valued commitment and articulated pride in keeping logistically challenging surveillance appointments [I always took them very seriously. . . If I’m scheduled for something by the doctor, I always make it.”]. The routine structure of VA care aligned with Veterans military experiences, facilitating compliance with doctor’s orders. However, procedural deviations in VA care were disconcerting for patients [“They haven’t reached out to me in at least three years, since my surgery; I was being seen once a year and then all of a sudden, they just quit.”]. While Veterans praised VA care, they exhibited sensitivity to signs of untoward treatment from clinical and support staff “…my surgeon, he never talked to me before, nor after, no anytime…I thought that maybe that wasn’t right”

Conclusions

Military culture embodies rank, order, and respect, and remains a source of strength and stability for Veterans in their medical care late in life. Cultural competency about how military service has shaped Veterans’ expectations can enhance providers’ awareness of patients’ military mindsets and inform surgeons’ efforts to engage Veterans in shared decision making.