"I've been really happy since I got that letter!": Longitudinal patient perspectives on lung cancer screening communication.

Objective: Experts recommend structured shared decision making when discussing lung cancer screening (LCS) and reporting low-dose computed tomography (LDCT) results. We examined patients' reactions to pre- and post-LDCT results communication processes at three medical centers in the US with established LCS programs.

Methods: Multicenter, qualitative, longitudinal study of patients considering and receiving LCS using data from semi-structured interviews guided by a patient-centered communication model using conventional content analysis.

Longitudinal Assessment of Communication With Patient-Reported Outcomes During Lung Cancer Screening.

Background: Many organizations recommend clinicians use structured communication processes, referred to as shared decision-making, to improve patient-reported outcomes for patients considering lung cancer screening (LCS).

Research Question: Which components of high-quality patient-centered communication are associated with decision regret and distress?

Study Design And Methods: We conducted a prospective, longitudinal, repeated measures cohort study among patients undergoing LCS in three different health care systems. We surveyed participants using validated measures of decision regret, decision satisfaction, distress, and patient-clinician communication domains up to 1 year after the low-dose CT (LDCT) imaging for LCS.

Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care.

Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust.

"We're On The Same Team": A Qualitative Study On Communication And Care Coordination Surrounding The Requirement To Quit Smoking Prior To Elective Orthopaedic Surgery.

Introduction: Many surgeons require patients to quit smoking prior to elective surgeries to reduce the risk of postoperative complications. Our aim was to qualitatively evaluate the communication and care experiences of patients and clinicians involved in conversations about quitting smoking prior to elective orthopaedic surgery.

Methods: A qualitative interview study of rural-residing Veterans, primary care providers (PCPs), and Veterans Administration (VA) orthopaedic surgery staff and pharmacists, who care for rural Veterans.

Association of patient and health care organization factors with incidental nodule guidelines adherence: A multi-system observational study.

Background: Health care organizations are increasingly developing systems to ensure patients with pulmonary nodules receive guideline-adherent care. Our goal was to determine patient and organization factors that are associated with radiologist adherence as well as clinician and patient concordance to 2005 Fleischner Society guidelines for incidental pulmonary nodule follow-up.

Materials: Trained researchers abstracted data from the electronic health record from two Veterans Affairs health care systems for patients with incidental pulmonary nodules as identified by interpreting radiologists from 2008 to 2016.

Primary Care Providers Experiences Implementing Low-Dose Computed Tomography Recommendations for Lung Cancer Screening.

Purpose: Describe primary care providers' (PCPs) barriers and facilitators to implementation of lung cancer screening programs in rural settings.

Methods: We conducted qualitative interviews with PCPs practicing in rural Oregon from November 2019 to September 2020. The interview questions and analytic framework were informed by the 2009 Consolidated Framework for Implementation Research.

"It Is A Carrot-Stick Model": A Qualitative Study of Rural-Serving Clinician and Rural-Residing Veteran Perceptions of Requirements to Quit Smoking prior to Elective Surgery.

Introduction: Some medical centers and surgeons require patients to stop smoking cigarettes prior to elective orthopaedic surgeries in an effort to decrease surgical complications. Given higher rates of smoking among rural individuals, rural patients may be disproportionately impacted by these requirements. We assessed the perceptions and experiences of rural-residing Veterans and clinicians related to this requirement.

Perspectives on advance care planning needs of persons with advanced dementia from their surrogates and clinicians.

Objectives: This study was designed to understand the experience and needs surrounding advance care planning (ACP) discussions for surrogate decision-makers of persons with advanced dementia (PWAD).

Methods: Semi-structured qualitative interviews based on end-of-life communication models with a convenience sample of 17 clinicians, and 15 surrogates of PWAD. We used a hybrid approach of deductive and inductive thematic analysis.

Implementing Smoking Cessation Telehealth Technologies Within the VHA: Lessons Learned.

Background: Health care systems need to reach patients who are smokers and connect them to evidence-based resources that can help them quit. Telehealth, such as an interactive voice response (IVR) system, may be one solution, but there is no roadmap to develop or implement an IVR system within the US Department of Veterans Affairs (VA).

Observations: We describe the development and implemention of IVR at the VA Portland Health Care System in Oregon to proactively reach veterans who use tobacco and connect them with cessation resources.

Emotional Distress, Anxiety, and General Health Status in Patients With Newly Identified Small Pulmonary Nodules: Results From the Watch the Spot Trial.

Background: Anxiety and emotional distress have not been studied in large, diverse samples of patients with pulmonary nodules.

Research Question: How common are anxiety and distress in patients with newly identified pulmonary nodules, and what factors are associated with these outcomes?

Study Design And Methods: This study surveyed participants in the Watch the Spot Trial, a large, pragmatic clinical trial of more vs less intensive strategies for radiographic surveillance of patients with small pulmonary nodules. The survey included validated instruments to measure patient-centered outcomes such as nodule-related emotional distress (Impact of Event Scale-Revised) and anxiety (Six-Item State Anxiety Inventory) 6 to 8 weeks following nodule identification.

Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making.

Objective: Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM).

Methods: We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content.

Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer.

Palliative care integration improves quality of life among patients with lung cancer and their families. Despite these benefits, significant barriers persist and patients do not receive timely integration. This study sought to identify facilitators of and barriers to integration in lung cancer care.

VA-Delivered or VA-Purchased Care: Important Factors for Veterans Navigating Care Decisions.

Background/objective: The VA MISSION Act aimed to increase Veterans' access to care by allowing eligible Veterans to use VA-paid care from non-VA providers ("VA-purchased care"). We interviewed Veterans who were eligible for both VA-delivered and VA-purchased care to examine factors they consider when making decisions about whether to use VA-delivered or VA-purchased care.

Methods: We conducted semi-structured interviews with 28 Veterans across the USA who were eligible for VA-delivered and VA-purchased care, using deductive and inductive analysis to develop themes.

"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.

Unlabelled: To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication.

Design: We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic.

Use of Veterans Health Administration Structured Data to Identify Patients Eligible for Lung Cancer Screening.

Introduction: Lung cancer screening (LCS) uptake is low. Assessing patients' cigarette pack-years and years since quitting is challenging given the lack of documentation in structured electronic health record data.

Materials And Methods: We used a convenience sample of patients with a chest CT scan in the Veterans Health Administration.

"It's a decision I have to make": Patient perspectives on smoking and cessation after lung cancer screening decisions.

Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial provider-patient LCS shared decision-making discussion and self-reported effects on smoking behaviors. We performed up to two successive semi-structured interviews to assess the experiences of 39 individuals who formerly or currently smoked cigarettes who underwent LCS decision-making discussions performed during routine care from three established US medical center LCS programs.

Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study.

Among patients with suspected early-stage non-small cell lung cancer (NSCLC), we sought to evaluate the association of patient-clinician communication (PCC) with patient-centered outcomes (PCOs). We conducted a multicenter, prospective cohort study examining PCOs at five time points, up to 12-months post-treatment. We used generalized estimating equation (GEE) models adjusted for sociodemographic and clinical variables to examine the relationship between PCC (dichotomized as high- or low-quality) and decisional conflict, treatment self-efficacy, and anxiety.

Study design for a proactive teachable moment tobacco treatment intervention among patients with pulmonary nodules.

Introduction: We developed Teachable Moment to Opt-Out of Tobacco (TeaM OUT) as a tobacco treatment intervention based on a foundation of a theoretical model of teachable moments, "naturally occurring life transitions or health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviors". The TeaM OUT intervention combines a teachable moment for patients with newly detected incidental pulmonary nodules with a proactive interactive voice response (IVR) system to increase connections to evidence-based tobacco treatment interventions.

Methods: We will perform a convergent, nested observational mixed-methods study utilizing both randomized trial and observational methods to test the effectiveness and generalizability of the TeaM OUT intervention through three aims.

The Influence of the COVID-19 Pandemic on Intensivists' Well-Being: A Qualitative Study.

Background: The COVID-19 pandemic has strained health care systems and has resulted in widespread critical care staffing shortages, negatively impacting the quality of care delivered.

Research Question: How have hospitals' emergency responses to the pandemic influenced the well-being of frontline intensivists, and do any potential strategies exist to improve their well-being and to help preserve the critical care workforce?

Study Design And Methods: We conducted semistructured interviews of intensivists at clusters of tertiary and community hospitals located in six regions across the United States between August and November 2020 using the "four S" framework of acute surge planning (ie, space, staff, stuff, and system) to organize the interview guide. We then used inductive thematic analysis to identify themes describing the influence of hospitals' emergency responses on intensivists' well-being.

The Chain of Adherence for Incidentally Detected Pulmonary Nodules after an Initial Radiologic Imaging Study: A Multisystem Observational Study.

Millions of people are diagnosed with incidental pulmonary nodules every year. Although most nodules are benign, it is universally recommended that all patients be assessed to determine appropriate follow-up and ensure that it is obtained. To determine the degree of concordance and adherence to 2005 Fleischner Society guidelines among radiologists, clinicians, and patients at two Veterans Affairs healthcare systems with incidental nodule tracking systems.

"It's Really Like Any Other Study": Rural Radiology Facilities Performing Low-Dose Computed Tomography for Lung Cancer Screening.

The majority of eligible people have not been screened for lung cancer. There is emerging evidence that there are location-based disparities applicable to lung cancer screening (LCS). To describe LCS radiologic services in rural Oregon and understand the barriers and facilitators to implementation of LCS using low-dose computed tomography (LDCT).

The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study.

Background: The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally.

Research Questions: Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists?

Study Design And Methods: Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system.