Conceptualizing the Core Components of Exposure-Informed Care

Background: Environmental exposures are common, may impact health, and may cause concerns. There have been calls to improve clinical care for exposure concerns through an “informed care” approach, which designs care in consideration of the patient’s experiences with the concern. Understanding Veterans’ experiences and concerns about military environmental exposures through an “informed care” approach may help with care; however, there is a need to better define the core components of this model of care. Objectives: The current project aimed to define the core components of “exposure-informed care” using a modified Delphi quality improvement study. Research Design: Delphi methodology utilizes expert opinion in a series of rounds and is appropriate to use when there is incomplete knowledge, uncertainty, or lack of evidence on a specific topic. Results: Experts in military environmental exposures (n=35) provided their feedback on the definition of “exposure-informed care.” After 4 rounds of rating, 20 statements were agreed upon as core components of exposure-informed care. Accepted statements about the core components of exposure-informed care were coded into a 6-part framework: (1) use concordant communication, (2) build trust, (3) provide resources and support, (4) assess and document, (5) take professional responsibility, and (6) integrate into care. Conclusions: The 6-part exposure-informed care framework represents experts’ definition of the core components of “exposure-informed care.” Future implementation of exposure-informed care and the impact of each theme are discussed.