Black US military veterans respond favourably to a booklet using narratives to normalise shared decision-making

Abstract

Background

Black Americans, including military veterans, experience worse health outcomes. In the United States, Black men have the highest lung cancer mortality and are less likely to undergo lung cancer screening (LCS). Mistrust caused by systemic racism can inhibit their participation in clinical conversations like shared decision-making (SDM). We sought to empower Black veterans to participate in SDM for LCS by normalising patients advocating for what matters most to them in clinical care decisions. We evaluated the impact of a booklet co-designed with veterans that includes four veteran narratives. They describe how each veteran began to trust their providers and engage in clinical conversations like SDM for LCS.

Study design

Pre-post intervention pilot study using surveys to evaluate the impact of the booklet and reactions to the narratives.

Methods

The survey was mailed to a random national sample of 450 Black veterans eligible for LCS but not yet screened. Respondents to the baseline survey were mailed the booklet and a follow-up survey.

Results

Thirty-nine veterans completed baseline and follow-up surveys. Mean agreement was above 3.0 (on a Likert scale of 1–5) for five statements about the booklet, with “Veterans eligible for screening should read” being the highest (mean 4.3). Information about LCS was rated most engaging (mean 3.2 on a scale of 1–4) and informative (3.3). The mean rating for veteran stories was 3.1 (engaging) and 2.9 (informative). Reactions to the narratives varied, including whether characters were relatable, likable, or influential. One narrative, describing a veteran slowly developing a trusting relationship with his provider, was particularly influential in encouraging respondents to talk with their doctor.

Conclusions

The positive reaction to the booklet supports the need to raise LCS awareness among LCS-eligible populations, and suggests that narratives may be a promising tool to increase engagement in care among Black veterans.