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PPO 14-113 – HSR&D Study

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PPO 14-113
Military Sexual Trauma Screening: Examining Patient Satisfaction and Preferences
Amy Elisabeth Street PhD
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA
Boston, MA
Funding Period: June 2015 - October 2016

BACKGROUND/RATIONALE:
In response to concerns about the healthcare needs of veterans who have experienced military sexual trauma (MST), VHA has implemented a universal MST Screening Program and extensive treatment resources targeting MST-related health conditions. Existing research has evaluated VHA's MST Screening Program from an organizational perspective, but there have been few efforts to examine patient perspectives.

OBJECTIVE(S):
The immediate objectives of this health services research pilot proposal are to better understand variations in veterans' attitudes about and preferences for MST screening, veterans' experiences with and satisfaction with their MST screening experiences, and associations between MST screening satisfaction, willingness to disclose an MST history, and health outcomes.

METHODS:
The design for this pilot study takes a mixed methods approach with a two-phase design in which our primary questions of interest are explored using both qualitative and quantitative methodologies, with qualitative work informing the constructs to be measured in subsequent quantitative work. Participants in the qualitative phase (N = 63) include Veterans who have been recently screened for MST at one of the eight VA healthcare facilities within VISN 1, VA New England Veterans Integrated Service Network, balanced across (1) gender and (2) those who endorse and those who deny experiences of MST. The draft quantitative survey instrument has been administered to a small number of individuals (N = 7) who meet the study inclusion criteria (i.e., screened for experiences of MST within past six months). Information gathered from these pilot interviews was critical for refining the survey instrument to test survey readability, survey length and participant comprehension of survey items. The final quantitative survey instrument is being administered to Phase 2 participants (N = 300) via mail survey.

FINDINGS/RESULTS:
A majority of Veterans in our sample reported that they were screened by a physician, nurse, or mental health provider, the majority of whom were white and female. Most screenings were conducted verbally in a primary or mental health care setting with providers that Veterans had just met. More than a third of the Veterans were not "screened" but instead preemptively disclosed to providers during an appointment; this disclosure mostly occurred when Veterans had a pre-established rapport with providers. Overall, Veterans rated their satisfaction of their screening/disclosure experiences on the higher side (above 8) although some male Veterans who experienced MST provided lower ratings (below 3). Reasons for Veterans' high satisfaction included: 1) brief screening process with no pressure from provider to discuss further; 2) the manner in which providers conducted the screening (e.g., providers were empathetic, compassionate, supportive); 3) Veteran comfort-level in discussing experiences with the screening provider. Reasons why Veterans were not satisfied included: 1) provider was perfunctory and moved on without acknowledging disclosure; 2) Veteran discomfort in discussing experiences with provider.

IMPACT:
The information gained from this project has been used to refine the questions used to assess veteran's experiences with the MST screening process and provided answers to methodological questions that will influence data collection procedures in future studies. Despite provider concerns that Veterans may feel uncomfortable discussing sensitive topics like MST during healthcare appointments, most Veterans in our study were comfortable with their screening experiences. Our study highlights the importance of provider reactions to Veterans when they disclose their experiences. Direct data from Veterans may help providers feel more comfortable to raise this important but sensitive topic. Critical next steps will be to educate providers on what we learned from this study about MST screening and the "dos and don'ts" associated with patient satisfaction.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: Diagnosis
Keywords: Clinical Diagnosis and Screening, Outcomes - Patient, Patient Preferences, Sexual Trauma/Assault
MeSH Terms: none

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