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.

VA seeks to promote patient-centered care in which Veterans' personal values, goals, and preferences drive health care plans. Cancer screening often involves a complex process whereby patients who do not exhibit any symptoms participate in repeated testing over sometimes inconsistent intervals over many years. Clinical recommendations do not account for variation in these perceptions over the course of cancer screening, and little is known about how they change over time and between screening intervals. Using lung and breast cancer screening initiatives as cases, this work will generate greater understanding of how perceptions of risk change throughout the screening process. We will develop guidance and materials for patients and providers to facilitate patient-centered shared decision-making in repeat cancer screening.