Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1028 — Patient Perspectives on Military Sexual Trauma (MST) Screening: Are Veterans Satisfied with Their Experiences?

Lead/Presenter: Amy Street
All Authors: Street AE (Women's Health Sciences Division, VA National Center for PTSD, VA Boston Healthcare System) Shin M (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System) Gormley K (Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System) Bell M (VA Mental Health Services National MST Support Team) Hamilton A (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System ) Vogt D (Women's Health Sciences Division, VA National Center for PTSD, VA Boston Healthcare System) Sadler A (Center for Comprehensive Access & Delivery Research & Evaluation, Iowa City VA Health Care System) Schnurr P (Executive Division, VA National Center for PTSD)

Objectives:
Responding to the healthcare needs of Veterans who have experienced military sexual trauma (MST), VHA implemented a universal MST Screening Program. Although this program has been evaluated from an organizational perspective, few efforts have assessed patient perspectives. The aim of this qualitative investigation was to understand veterans' satisfaction with their own MST screening experiences.

Methods:
Participants were 63 Veterans whose electronic medical records (EMR) indicated MST screening within the past six months at a VA New England (VISN 1) facility. We conducted semi-structured telephone interviews with 23 men and 20 women whose EMR indicated that they had disclosed experiences of MST and 9 men and 11 women whose EMR indicated that they denied experiences of MST. Interviews were audio-recorded and transcribed verbatim. We coded data using a standardized rapid assessment approach, conducted iterative inter-coder reliability checks, and reduced and analyzed data using a matrix.

Results:
Most screenings were conducted verbally in a primary or mental health care setting. More than a third of the Veterans were not "screened" but instead preemptively disclosed MST experiences to providers; this disclosure frequently occurred when Veterans had an established relationship with providers. Overall, Veterans rated their satisfaction with screening/disclosure experiences positively (generally above 8 on 1-10 scale), although some male Veterans who experienced MST provided lower ratings (below 3). Reasons for Veterans' high satisfaction included a brief process with no pressure from provider to discuss further and providers' manner during the screening (e.g., perceived as empathetic, compassionate, supportive). Reasons why Veterans were not satisfied included perceptions that provider was perfunctory (e.g., provider moved on without sufficiently acknowledging disclosure) and veterans' general discomfort discussing sensitive experiences.

Implications:
Despite provider concerns that Veterans may feel uncomfortable discussing sensitive topics like MST during healthcare appointments, most Veterans were comfortable with their screening experiences. However, further attention must be given to the experiences of male Veterans with histories of MST, who were the least positive about these encounters.

Impacts:
Data documenting Veterans' comfort may increase provider willingness to raise this important but sensitive topic. A critical next step is to educate providers about screening "dos and don'ts" associated with patient satisfaction.