"It's a Donut!" - Veterans' perspectives of lung cancer screening with low-dose computed tomography.

[OBJECTIVES] Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality, yet utilization remains low nationally and in the United States Veterans Health Administration. The aim of this qualitative study was to explore Veteran-perceived factors influencing the lung cancer screening experience and to elicit Veteran-identified strategies for improving lung cancer screening.

[METHODS] From January 1, 2021, to August 6, 2021, we conducted a cross-sectional qualitative study of in-depth interviews with Veterans at a single Veterans Affairs Medical Center (VAMC). We interviewed Veterans (n = 34) who were referred to the VAMC's lung cancer screening program, including those who enrolled in the program and those who did not, and utilized the Socio-Ecological Model for qualitative data analysis and used an inductive and deductive approach to identify emerging themes.

[RESULTS] Participants indicated that factors influencing the lung cancer screening experience include lack of knowledge about screening, patterns in provider-patient communication, geographic barriers to pursuing screening (e.g. rural residence) and cultural and generational differences. Veteran-identified strategies to improve lung cancer screening included: 1) developing Veteran-centric education to increase awareness of lung cancer screening eligibility criteria, availability, and processes (emphasizing key features such as non-invasive, quick, low/no cost, distinct from magnetic resonance imaging (MRI) and other imaging modalities; 2) improving communication between healthcare providers and Veterans and leveraging trusted relationships with primary care providers; 3) improving CT screening room comfort to meet Veteran needs; and 4) offering mobile screening to increase access for Veterans who reside in rural areas.

[CONCLUSIONS] Veterans identified many strategies to improve lung cancer screening. Strategies include developing Veteran-centric education, improving provider-patient communication and trust, considering CT room re-design, and offering mobile screening services.

[PRACTICE IMPLICATIONS] Veteran-identified strategies to improve the lung cancer screening experience can improve utilization of lung cancer screening in and beyond the Veterans Health Administration.