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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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4087 — Patient Risk Perception and Decision-Making about Repeat Cancer Screening

Lead/Presenter: Chris Gillespie,  COIN - Bedford/Boston
All Authors: Gillespie C (Center for Healthcare Organization and Implementation Research (CHOIR)), Boudreau J (CHOIR-Bedford) Dunlap S (CHOIR-Bedford) Zogas A (CHOIR-Boston) McCullough MB (CHOIR-Bedford)

Objectives:
VA seeks to promote patient-centered care in which Veterans’ personal values, goals, and preferences drive healthcare plans. Involving patients in their care can produce better health outcomes. Routine lung cancer screening (LCS) through chest CT and breast cancer screening (BCS) through mammography involves repeated testing over sometimes inconsistent intervals over many years. These are essential sites to promote patient-centeredness. Adherence to repeat cancer screening tends to decline over time, yet we currently have little understanding of how Veterans make decisions about returning for repeat screening, including how the results of prior screening tests affect their risk perceptions, and what other factors may influence adherence decisions.

Methods:
This is an ongoing longitudinal qualitative study that involves in-depth interviews with Veterans throughout the screening process for LCS and BCS. Veterans will be interviewed at three points in time: 1) prior to the initial screening exam; 2) following that initial exam; and 3) after a subsequent screening exam. We report here data from the first period. Interviews were conducted with 20 Veterans undergoing LCS and 25 women Veterans undergoing BCS (n = 45). Participants were asked questions regarding their perceptions of risk for lung or breast cancer, their decision-making about initiating screening, their understanding of the screening process, and about their intentions regarding future screening exams.

Results:
RISK PERCEPTIONS: Perceptions of increased risk motivated participants to accept an invitation to begin screening. These perceptions were influenced by age, smoking history (for LCS) or family history (for BCS). Veterans undergoing LCS considered convenience and favored the noninvasiveness of the screening method. Although Veterans undergoing BCS relayed painful or uncomfortable screening experiences of friends and family members, these accounts did not typically deter Veterans from initiating screening. DECISION-MAKING and PREFERENCES: Participants identified several factors that influenced their decisions to initiate screening. For many, LCS and BCS were considered routine healthcare activities and many participants were motivated to follow a trusted healthcare provider’s recommendation to get screened. Veterans with questions about screening often did not ask. Many participants were unaware of guidelines for how often repeat screening exams should occur and preferred to get these exams at intervals that exceeded those guidelines. For example, several women stated that subsequent mammograms should occur at 3-5 year intervals, rather than the recommended biennial exams. These preferences reflected perceptions of low risk for breast cancer.

Implications:
Veterans’ decision-making and intentions about repeat cancer screening accounts for factors that are often not accounted for in national guidelines. These factors include individual perceptions of risk, the experience of getting screened, and personal preferences about the frequency of screening. Patients were often not familiar with the screening process and recommended screening intervals and preferred longer intervals between screening exams.

Impacts:
Patient-centered care empowers Veterans to make healthcare decisions that align with their personal values, goals, and preferences. The decision about whether or not to continue with cancer screening should be no exception. Being sensitive to factors that influence Veterans’ decisions about repeat cancer screening will improve patient experiences of care and satisfaction with VA healthcare.