Barker Anna M, Wiener Renda Soylemez, Reisman Joel, Kearney Lauren, Dones Makayla, Fix Gemmae M
Center for Health Optimization and Implementation Research (CHOIR), VA Bedford Healthcare System and VA Boston Healthcare System, USA.
National Center for Lung Cancer Screening, Veterans Health Administration, USA.
Public Health Pract (Oxf). 2025 Mar 23;9:100606. doi: 10.1016/j.puhip.2025.100606. eCollection 2025 Jun.
Black Americans, including military veterans, experience worse health outcomes. In the United States, Black men have the highest lung cancer mortality and are less likely to undergo lung cancer screening (LCS). Mistrust caused by systemic racism can inhibit their participation in clinical conversations like shared decision-making (SDM). We sought to empower Black veterans to participate in SDM for LCS by normalising patients advocating for what matters most to them in clinical care decisions. We evaluated the impact of a booklet co-designed with veterans that includes four veteran narratives. They describe how each veteran began to trust their providers and engage in clinical conversations like SDM for LCS.
Pre-post intervention pilot study using surveys to evaluate the impact of the booklet and reactions to the narratives.
The survey was mailed to a random national sample of 450 Black veterans eligible for LCS but not yet screened. Respondents to the baseline survey were mailed the booklet and a follow-up survey.
Thirty-nine veterans completed baseline and follow-up surveys. Mean agreement was above 3.0 (on a Likert scale of 1-5) for five statements about the booklet, with "Veterans eligible for screening should read" being the highest (mean 4.3). Information about LCS was rated most engaging (mean 3.2 on a scale of 1-4) and informative (3.3). The mean rating for veteran stories was 3.1 (engaging) and 2.9 (informative). Reactions to the narratives varied, including whether characters were relatable, likable, or influential. One narrative, describing a veteran slowly developing a trusting relationship with his provider, was particularly influential in encouraging respondents to talk with their doctor.
The positive reaction to the booklet supports the need to raise LCS awareness among LCS-eligible populations, and suggests that narratives may be a promising tool to increase engagement in care among Black veterans.
包括退伍军人在内的美国黑人健康状况较差。在美国，黑人男性肺癌死亡率最高，且接受肺癌筛查（LCS）的可能性较小。系统性种族主义引发的不信任会阻碍他们参与诸如共同决策（SDM）等临床对话。我们试图通过使患者在临床护理决策中为对自己最重要的事情发声常态化，来增强黑人退伍军人参与肺癌筛查共同决策的能力。我们评估了一本与退伍军人共同设计的手册的影响，该手册包含四个退伍军人的故事。这些故事描述了每位退伍军人如何开始信任他们的医疗服务提供者，并参与诸如肺癌筛查共同决策等临床对话。
采用前后干预试点研究，通过调查评估手册的影响以及对故事的反应。
将调查问卷邮寄给全国450名符合肺癌筛查条件但尚未接受筛查的黑人退伍军人的随机样本。向基线调查的受访者邮寄手册和后续调查问卷。
39名退伍军人完成了基线和后续调查。对于关于手册的五条陈述，平均同意度高于3.0（李克特量表1 - 5），其中“符合筛查条件的退伍军人应该阅读”这一陈述同意度最高（平均4.3）。关于肺癌筛查的信息被评为最具吸引力（1 - 4分制下平均3.2）和信息量最大（3.3）。退伍军人故事的平均评分是3.1（有吸引力）和2.9（信息量）。对故事的反应各不相同，包括人物是否容易产生共鸣、是否讨人喜欢或具有影响力。其中一个故事描述了一名退伍军人与他的医疗服务提供者逐渐建立起信任关系，这个故事在鼓励受访者与医生交谈方面特别有影响力。
对手册的积极反应支持了在符合肺癌筛查条件的人群中提高肺癌筛查意识的必要性，并表明故事可能是增加黑人退伍军人参与医疗护理的一个有前景的工具。
