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

背景：退伍军人事务部旨在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 先前的筛查测试影响他们的风险感知，以及其他信息来源如何影响依从性 决策知识授权价值观和健康信念模型已被应用于决策 关于筛查摄取。本研究将扩展该模型，以解释重复筛选决策。 意义：患者决定进行常规筛查和返回进行重复筛查的时间是 VA倡议的成功或失败的核心，以改善筛查。使用乳腺癌筛查（BCS）和 肺癌筛查（LCS）的情况下，这项工作将产生更多的了解如何感知风险 在整个筛选过程中发生变化。我们将开发患者驱动的信息材料， 在筛选前给予患者，并纳入筛选结果报告中， 提供者和患者之间的沟通是以退伍军人为中心的决策。这些发现将 也能够从肺癌和乳腺癌筛查扩展到其他癌症筛查项目。 创新和影响：这项研究的独特之处在于，我们将使用多种癌症筛查计划 作为案例来了解重复筛查决策。肺癌和乳腺癌筛查是 具有重要相似性和差异性的案例，为更全面地研究许多因素提供了机会 退伍军人在决定是否返回进行重复筛查时会考虑。为此，我们将制定一项 更广泛地了解退伍军人如何参与筛选过程以及对风险的看法 在这个过程中的变化。这也可以为共同决策的实施提供信息， 以病人为中心的护理，在筛选程序的其他条件，涉及重复的例行筛选。 具体目标：目标1-表征影响患者决定重复癌症筛查的因素。 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读 检查结果，修改他们对风险的看法，并决定是否重复LCS和BCS。 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完善他们的信息来源时所利用的各种信息来源。 对风险和脆弱性的认识，以及对他们认为有用的方式和格式的评估。 目的2 -比较风险的看法和筛选经验的退伍军人接受肺和 乳腺癌筛查，以确定重复癌症筛查的决策模式。 目标3 -开发患者驱动的材料，优化以患者为中心的关于重复癌症的决策 筛选 研究方法：本研究是一项关于退伍军人复修决策的纵向质性研究 筛查LCS和BCS。该研究旨在优化LCS和 BCS对重复癌症筛查决策的普遍理解的发展。我们 将采访35名退伍军人谁发起了LCS和35名妇女退伍军人谁发起了BCS。我们将 尝试在3个时间点采访参与者：1）初步筛选前，2）初步筛选后不久， 和3）在推荐的重复筛查（年度或监测）之后。我们将比较和对比这些 经验，为重复癌症筛查决策的概念模型的发展提供信息。 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， 协助退伍军人做出有关重复癌症筛查的决定。我们的业务合作伙伴将协助 通过信息传递活动和其他外联活动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.