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Center for Care Delivery and Outcomes Research

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Primary Care for Women with Past Trauma

Primary Care for Women with Past Trauma

Elisheva Danan, MD, MPH, has been working with the Minnesota Learning Health Systems Mentored Career Development Program to develop and implement trauma-sensitive, patient-centered primary and preventive healthcare practices for women Veterans who have experienced sexual assault.

Dr. Danan participates in a biweekly “Design Shop” with other MN-LHS Scholars and invited speakers to discuss Learning Health Systems theory and application.

Background:  Sexual assault affects 1 in 3 U.S. women and has lifelong consequences for women’s health that can include a more than two-fold cervical cancer risk. Pap testing dramatically decreases cervical cancer rates, but women who have experienced sexual assault face barriers to testing. One quarter of women in the VA report military sexual trauma, which may affect their care. A promising new approach to cervical cancer screening would use a self-collected vaginal swab in place of a pelvic exam. This research forms the groundwork for implementing self-collected testing as a patient-centered option in VA.
Methods:  Learning Health Systems Research is patient-engaged and strives to create sustainable improvements in healthcare delivery. We are conducting three studies to better understand women’s experiences with cervical cancer screening in VA and perspectives on self-collected testing. The first study combines responses to a multisite survey of women Veterans across 12 VAs in 9 states with medical record data to evaluate Pap test completion. The second study is a retrospective cohort of a nationally representative sample of women Veterans that will describe concordance with cervical cancer screening guidelines in VA. The third study involves qualitative interviews with patients and health system stakeholders at the Minneapolis VA.

Findings and Next Steps: We have found that nearly 60% of women Veterans who use VA care have experienced sexual assault in their lifetimes, and that women who have been assaulted were more than twice as likely as other women to report high anxiety, distress, and discomfort with gynecologic exams. They were also twice as likely to report delaying a gynecologic exam due to distress. Ongoing work will help us understand and improve women Veterans’ screening experiences in VA. We plan to use our results to develop a pilot study for self-collected cervical cancer screening in VA.

Watch this short clip from the Twin Cities PBS documentary series “Our Invisible Guardians” to learn more about the Learning Health Systems initiative.