scholarly journals Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening

2020 ◽  
Vol 5 (1) ◽  
pp. 238146831989145
Author(s):  
Jamie L. Studts ◽  
Richard J. Thurer ◽  
Kory Brinker ◽  
Sarah E. Lillie ◽  
Margaret M. Byrne
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Online Survey ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Increased Risk

Background. Recent data and policy decisions have led to the availability of lung cancer screening (LCS) for individuals who are at increased risk of developing lung cancer. In establishing implementation policies, the US Preventive Services Task Force recommended and the Centers for Medicare and Medicaid Services required that individuals who meet eligibility criteria for LCS receive a patient counseling and shared decision-making consultation prior to LCS. Methods. This study evaluated the potential of a values clarification/preference elicitation exercise and brief educational intervention to reduce decisional conflict regarding LCS. Participants ( N = 210) completing a larger online survey responded to a measure of decisional conflict prior to and following administration of a conjoint survey and brief educational narrative about LCS. The conjoint survey included 22 choice sets (two of which were holdout cards), incorporating 5 attributes with 17 levels. Results. Results pertaining to changes in decisional conflict showed that participants reported statistically significantly and clinically meaningful reductions in decisional conflict following administration of the brief educational narrative and conjoint survey across the total score (Δ = 29.30; d = 1.09) and all four decisional conflict subscales: Uncertainty (Δ = 27.75; d = 0.73), Informed (Δ = 35.32; d = 1.11), Values Clarity (Δ = 31.82; d = 0.85), and Support (Δ = 18.78; d = 0.66). Discussion. While the study design precludes differentiating the effects of the brief educational narrative and the conjoint survey, data suggest that these tools offer a reasonable approach to clarifying personal beliefs and perspectives regarding LCS participation. Given the complicated nature of LCS decisions and recent policies advocating informed and shared decision-making approaches, conjoint surveys should be evaluated as one of the tools that could help individuals make choices about LCS participation.

scholarly journals Implementation of Shared Decision Making for Lung Cancer Screening Among the Privately Insured Nonelderly

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832098477
Author(s):  
Ya-Chen Tina Shih ◽  
Ying Xu ◽  
Lisa M. Lowenstein ◽  
Robert J. Volk
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Private Insurance ◽  
Lung Cancer Screening ◽  
Shared Decision ◽  
Factors Associated ◽  
Coverage Policy ◽  
Privately Insured

Introduction. The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Methods. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. Results. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 ( P < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 ( P < 0.0001). Limitations. Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. Conclusions. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.

scholarly journals Aiding shared decision making in lung cancer screening: two decision tools

2020 ◽  
Author(s):  
Shelby R Sferra ◽  
Joyce S Cheng ◽  
Zachary Boynton ◽  
Verdi DiSesa ◽  
Larry R Kaiser ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Prospective Trial ◽  
Lung Cancer Screening ◽  
Current Evidence ◽  
Shared Decision ◽  
Decision Regret

Abstract Background Shared decision making (SDM) preceding lung cancer screening is important for populations that are underrepresented in lung cancer screening trials. Current evidence-based guidelines; however, do not address personal risk and outcomes in underrepresented populations. This study compared two SDM decision aids (Option Grids and Shouldiscreen.com) for SDM efficacy, decision regret and knowledge. Methods We conducted a prospective trial of lung cancer screening patients (N = 237) randomized to SDM with Option Grids or Shouldiscreen.com. To evaluate the SDM process after lung cancer screening, patients answered two questionnaires: CollaboRATE and Decision Regret. Patients also completed a questionnaire to test their knowledge of lung cancer screening. Results Patients were predominantly African American (61.6%), though multiple races, varying education levels and equal genders were represented. Patients in both Option Grids and Shouldiscreen.com groups reported favorable SDM experiences (P = 0.60) and equivalent knowledge about lung cancer screening (P = 0.43). Patients using Shouldiscreen.com had less knowledge regarding the potential complications of subsequent testing (P = 0.02). Shouldiscreen.com patients had increased regret regarding their decision to pursue screening (P = 0.02). Conclusions Option Grids and Shouldiscreen.com both facilitated a meaningful SDM process. However, Option Grids patients experienced decreased decision regret and enhanced knowledge of the potential complications of screening.

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