Lung cancer is the leading cause of cancer death in the United States and among veterans treated by the Veterans Health Administration (VHA). Many veterans are at increased risk for lung cancer due to high smoking rates and exposure to carcinogens in the line of duty. Recently, the National Lung Screening Trial demonstrated a 20 percent reduction in lung cancer mortality with low-dose computed tomography (LDCT) screening of high-risk smokers. Questions have arisen regarding how best to implement LDCT. LDCT has risks as well as benefits, and some risk groups were not studied. Clearly, patients’ involvement in patient-centered outcomes research (PCOR) is needed for identifying optimal LDCT implementation strategies. The project team proposes to facilitate the engagement of veterans in efforts to study optimal use of cancer screening. The project team will target veterans from different racial backgrounds in Southeast Wisconsin, where the researchers have deep connections to the veteran community from their prior work. The objectives of the proposal are:

• Use evidence-based strategies to recruit a diverse cohort of veterans motivated to serve in the patient advisory council (PAC) as stakeholder advisors
• Build a stakeholder group (SG), including representatives from veteran advocacy groups and the healthcare system, healthcare providers, researchers, and administrators
• Identify patient-centered comparative clinical effectiveness research (CER) questions regarding optimizing LDCT implementation that are of greatest concern to the PAC through an engaged process with the PAC and SG
• Maintain a sustained PAC with capacity and readiness to engage with researchers, clinicians, and other stakeholders regarding CER and PCOR projects on optimization of lung cancer screening tests. This PAC will be integrated into the Medical College of Wisconsin cancer center for future referral of other potential patients for training on PCOR-related topics. 

This project will directly lead to a diverse, well-informed panel of Southeast Wisconsin veterans with experience in dynamic dialogue with other relevant stakeholders. These veterans will help ensure the research addresses issues that matter to patients, using methods that will attract participation by the target population for LDCT. Moreover, veterans and participating organizations will be motivated to disseminate the results of the studies they helped design. The national reach of Veterans Service Organization (VSO) partners will facilitate wide dissemination of engagement efforts. This extends beyond veterans, as local VSO leaders also tend to be leaders in other community organizations. In addition to the impact on research regarding lung cancer screening using LDCT, this project will provide a model for efforts to ensure patient input in research on how to optimize screening for other screen-detectable cancers with different risk-benefit trade-offs and at-risk populations (e.g., breast, colorectal, and gastric cancers). The engagement plan of this proposal is consistent with the PCORI engagement principles. The PAC will have a series of meetings to discuss their own experiences related to LDCT and lung cancer as well as ways of improving their experience of care and eventually reducing death rates from lung cancer. The SG and PAC will also have joint meetings to learn from one another, develop research agendas in partnership, and celebrate success.