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Interventions are needed to overcome a key barrier to patient-provider communication, namely that patients hesitate to participate in clinical conversations because they believe their expected role is to be passive. This expectation is reinforced for veterans, who replicate their experience of military hierarchy in the patient-provider relationship. Black veterans, moreover, encounter structural racism that compounds this power imbalance. This paper describes a co-designed intervention to empower Black veterans to talk with providers, using shared decision-making (SDM) for lung cancer screening (LCS) as an exemplar. We worked with a diverse group of 5 veterans to develop materials that normalize participating in clinical conversations. We then interviewed 10 Black veterans selected from a national sample to assess the booklet’s impact and contextual factors. The co-design team produced a 30-page booklet that includes veteran narratives describing positive clinical interactions, as well as didactic information about SDM and LCS. We identified four themes related to Black veteran participants’ healthcare experience: (1) they want truthful and complete information exchange with providers they know; (2) they often feel their concerns are disregarded; (3) poor communication worsens medical treatment; and (4) they are confused and angry about treatment in clinical encounters that they feel are racist. The booklet was described as interesting and informative. The veteran narratives in the booklet particularly resonated with readers. Assessment of the booklet’s overall impact on planned engagement with providers varied. Co-designed materials that normalize participation in clinical encounters can play a role in reducing disparities in patient-provider communication. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens.

Although COVID-19 vaccines have been available to many U.S. Veterans Affairs (VA) healthcare system employees and Veteran patients since early 2021, vaccine receipt data indicates some groups are not receiving them. Our objective was to conduct a rapid qualitative assessment of Veterans’ and VA employees’ views on COVID-19 vaccination to inform clinical leaders’ ongoing efforts to increase vaccine uptake across the VA. We employed semi-structured interviews and a focus group involving employees and Veterans as part of a quality improvement project between January and June 2021 at three VA medical centers. Thirty-one employees and 27 Veterans participated in semi-structured interviews; 5 Veterans from a national stakeholder organization participated in a focus group. Data were analyzed using directed content analysis, involving an a priori coding framework comprised of four domains with subcodes under each: contextual influences, barriers and facilitators, vaccine-specific issues, and VA/military experiences. We then classified initial codes into five categories of hesitancy: vaccine deliberation, dissent, distrust, indifference and skepticism. A subset of Veterans (n = 14) and employees (n = 8) identified as vaccine hesitant. Vaccine hesitancy categories were represented by subcodes of religion, culture, gender or socio-economic factors, perceptions of politics and policies, role of healthcare providers, and historical influences; (contextual influences); knowledge or awareness of vaccines, perceived susceptibility to COVID-19, and beliefs and attitudes about health and illness (barriers and facilitators); vaccine development process (vaccine-specific issues) and military experiences (VA/military factors). Facilitators involved talking with trusted others, ease of vaccine access, and perceptions of family and societal benefits of vaccines. Vaccine hesitancy is multi-faceted and likely requires multiple strategies for engaging in conversations to address Veteran and VA employee concerns. Messages should involve patient-centered communication strategies delivered by trusted healthcare providers and peers and should focus on addressing expected benefits for family, friends, and society.