Patient Risk Perception and Decision-Making about Adherence to Repeat Cancer Scr

背景：退伍军人协会寻求促进以患者为中心的护理，其中退伍军人的个人价值观和目标驱动 医疗保健计划。让患者参与他们的护理可以产生更好的健康结果。我们目前几乎没有 了解退伍军人如何决定是否返回进行重复筛查，包括结果如何 先前的筛查测试会影响他们的风险认知，以及其他信息来源如何影响他们的坚持 决定。知识-赋权-价值观和健康信念模型已被应用于决策 关于筛查摄取。这项研究将扩展该模型，以考虑重复筛查决定。 意义：患者决定进行常规筛查并返回进行重复筛查的决定位于 退伍军人管理局改进筛查的倡议成败的核心。使用乳腺癌筛查(BCS)和 肺癌筛查(LCS)作为病例，这项工作将产生更大的理解，如何感知风险 在整个筛选过程中发生变化。我们将开发以患者为导向的信息材料，这些材料可以 在筛查前给予患者，以及包括在筛查结果报告中，这可以告知 以退伍军人为中心的提供者和患者之间的沟通决策。这些发现将 也能够扩展到肺癌和乳腺癌筛查以外的其他癌症筛查项目。 创新和影响：这项研究是独一无二的，因为我们将使用多种癌症筛查计划 作为病例了解重复筛查决策。肺癌和乳腺癌筛查是 具有重要相似和不同之处的案例提供了更充分地检查许多因素的机会 退伍军人在决定是否回来进行重复检查时会考虑的因素。在此过程中，我们将制定一个 更广泛地了解退伍军人如何参与筛查过程以及如何感知风险 在整个过程中进行更改。这也可能有助于实施共享决策和 以患者为中心的护理在筛查项目中涉及重复常规筛查的其他情况。 具体目标：目标1-确定影响患者进行重复癌症筛查决定的因素。 目标1a-确定正在接受肺癌和乳腺癌筛查的退伍军人如何解释 筛查结果，修正他们对风险的认知，并做出关于重复LCS和BCS的决定。 目标1b-确定影响退伍军人如何做出重复癌症筛查决定的因素。 重点将是确定退伍军人在精炼他们的过程中利用的信息来源的多样性 对风险和脆弱性的看法，以及对他们认为的风格和格式的评估将是有用的。 目的2-对比退伍军人接受肺和肺移植手术的风险认知和筛查经验 乳腺癌筛查，以明确重复癌症筛查的决策模式。 目标3-开发以患者为导向的材料，这将优化以患者为中心的关于复发癌症的决策 放映。 研究方法：这是一项关于退伍军人决定返乡留学的纵向定性研究。 筛查LCS和BCS。这项研究旨在优化LCS和LCS之间的信息比较 BCS有助于发展对重复癌症筛查决策的普遍理解。我们 将采访35名发起LCS的退伍军人和35名发起BCS的女性退伍军人。我们会 尝试在3个时间点采访参与者：1)在初始筛选之前，2)在初始筛选之后不久， 3)推荐的重复筛查(年度筛查或监测)后。我们将对这些进行比较和对比 为制定重复癌症筛查决策的概念模型提供信息的经验。 下一步/实施：我们将与专家小组合作开发以患者为中心的材料，以 帮助退伍军人做出关于重复癌症筛查的决定。我们的运营合作伙伴将协助 通过宣传活动和其他外展努力向患者和提供者传播材料。

Background: VA seeks to promote patient-centered care in which Veterans' personal values and goals drive health care plans. Involving patients in their care can produce better health outcomes. We currently have little understanding of how Veterans make decisions about returning for repeat screening, including how results of prior screening tests affect their risk perceptions, and how other sources of information influence adherence decisions. The Knowledge-Empowerment-Values and Health Belief models have been applied to decisions about screening uptake. This study will extend that model to account for repeat screening decisions. Significance: Patients' decisions to engage in routine screening and return for repeat screening are at the core of the success or failure of VA initiatives to improve screening. Using breast cancer screening (BCS) and lung cancer screening (LCS) as cases, this work will generate greater understanding of how perceptions of risk change throughout the screening process. We will develop patient-driven materials for information that can given to patients prior to screening, as well as included in the reporting of screening results, that can inform communication between providers and patients decision-making that is Veteran-centered. These findings will also be able to be extended beyond lung and breast cancer screening to other cancer screening programs. Innovation and Impact: This study is unique in that we will be using multiple programs of cancer screening as cases to understand repeat screening decision-making. Lung cancer and breast cancer screening are cases with important similarities and differences that offer opportunities to more fully examine the many factors that Veterans consider when deciding to return, or not, for repeat screening. In doing so, we will develop a broader understanding of how Veterans engage with the screening process and how perceptions of risk change throughout this process. This may also inform the implementation of shared decision-making and patient-centered care in screening programs for other conditions that involve repeated routine screenings. Specific Aims: Aim 1-Characterize elements that influence patients' decisions about repeat cancer screening. Aim 1a – Ascertain how veterans who are undergoing lung and breast cancer screening interpret the results of screening exams, revise their perceptions of risk, and make decisions about repeat LCS and BCS. Aim 1b – Identify factors that influence how Veterans make decisions about repeat cancer screening. The focus will be on determining the variety of sources of information Veterans have utilized as they refine their perceptions of risk and vulnerability, and an evaluation of the styles and formats they feel would be useful. Aim 2 – Contrast the perceptions of risk and the screening experiences of Veterans undergoing lung and breast cancer screening to specify a model of decision-making in repeat cancer screening. Aim 3 – Develop patient-driven materials and that will optimize patient-centered decisions about repeat cancer screening. Methodology: This is a longitudinal qualitative study of Veterans' decisions about returning for repeat screening for LCS and BCS. The study is designed to optimize informative comparisons between LCS and BCS toward the development of a generalized understanding of repeat cancer screening decision-making. We will interview 35 Veterans who have initiated LCS and 35 Women Veterans who have initiated BCS. We will attempt to interview participants at 3 time points: 1) before initial screening, 2) shortly after initial screening, and 3) after recommended repeat screening (annual, or surveillance). We will compare and contrast these experiences to inform development of a conceptual model of repeat cancer screening decision-making. Next Steps/Implementation: We will work with an expert panel to develop patient-centered materials to assist Veterans in making decisions about repeat cancer screening. Our operational partners will assist with disseminating materials to patients and providers through messaging campaigns and other outreach efforts.