Lung Cancer Screening Benefits and Harms Stratified by Patient Risk: Information to Improve Patient Decision Aids

Abstract Lung cancer screening of high-risk individuals with computed tomography is a promising intervention to reduce lung cancer mortality. Patient Decision Aids (PtDAs) may assist eligible individuals assess the risks and benefits associated with screening. Screening preference is high among lower-risk, screening-ineligible individuals and strategies are needed to reduce screening demand among this group. We developed and evaluated a resource comprising a recruitment pamphlet combined with either a PtDA for screening-eligible individuals or an education pamphlet for screening-ineligible individuals. Quasi-experimental pre-post pamphlet exposure design. Ever-smokers aged 55–80 years attending hospital outpatient clinics were invited. Among screening-eligible participants, the assessed outcome was change in score on the Decisional Conflict Scale (DCS). Among screening-ineligible participants, the assessed outcomes were change in screening preference. In the study 51% (55/107) of invited individuals participated, with mean ± standard deviation age 66.9 ± 6.4 years, 53% (29/55) male, and 65% (36/55) eligible for screening. Median (interquartile range) DCS among screening-eligible participants reduced from 28.9 (22.7–45.3) pre-PtDA to 25 (1.6–29.7) post-PtDA (p < .001), but there was no significant change in the proportion that reached the accepted threshold for decisional certainty (DCS < 25, 10/36 [28%] pre-exposure vs. 14/36 [39%] post-exposure, p = .1). Screening preference among screening-ineligible individuals reduced after viewing the screening-ineligible brochure (pre-exposure median of “Prefer” to post-exposure median of “Unsure,” p = .001). Our consumer information pamphlets about lung cancer screening may reduce decisional conflict and improve alignment of screening preference with eligibility.

Download Full-text

Providers at an Academic Safety-Net Hospital System Tend to Refer Patients for Lung Cancer Screening Based on Patient Risk, but Demographic Disparities Persist

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a1004 ◽

2019 ◽

Author(s):

D.J. Kats ◽

Y. Adie ◽

A. Tlimat ◽

Y. Tarabichi

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Lung Cancer Screening ◽

Safety Net ◽

Patient Risk ◽

Hospital System ◽

Safety Net Hospital

Download Full-text

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

Journal of Public Health ◽

10.1093/pubmed/fdaa063 ◽

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.

Download Full-text

Feasibility of a patient decision aid about lung cancer screening with low-dose computed tomography

Preventive Medicine ◽

10.1016/j.ypmed.2014.02.006 ◽

2014 ◽

Vol 62 ◽

pp. 60-63 ◽

Cited By ~ 53

Author(s):

Robert J. Volk ◽

Suzanne K. Linder ◽

Viola B. Leal ◽

Vance Rabius ◽

Paul M. Cinciripini ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Cancer Screening ◽

Decision Aid ◽

Low Dose ◽

Lung Cancer Screening ◽

Patient Decision Aid ◽

Patient Decision ◽

Low Dose Computed Tomography

Download Full-text

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

MDM Policy & Practice ◽

10.1177/23814683211067810 ◽

2021 ◽

Vol 6 (2) ◽

pp. 238146832110678

Author(s):

Kristin G. Maki ◽

Kaiping Liao ◽

Lisa M. Lowenstein ◽

M. Angeles Lopez-Olivo ◽

Robert J. Volk

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Intervention Group ◽

Secondary Analysis ◽

Lung Cancer Screening ◽

Smoking History ◽

Anticipated Regret ◽

Factors Associated ◽

Patient Decision ◽

Low Dose Computed Tomography

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

Download Full-text

What Is the Effectiveness of Patient Decision Aids for Cancer-Related Decisions? A Systematic Review Subanalysis

JCO Clinical Cancer Informatics ◽

10.1200/cci.17.00148 ◽

2018 ◽

pp. 1-13 ◽

Cited By ~ 16

Author(s):

Kristen McAlpine ◽

Krystina B. Lewis ◽

Lyndal J. Trevena ◽

Dawn Stacey

Keyword(s):

Decision Making ◽

Cancer Screening ◽

Decision Aid ◽

Weighted Mean Difference ◽

Decision Aids ◽

Decision Making Process ◽

Patient Decision Aid ◽

Weighted Mean ◽

Patient Decision Aids ◽

Patient Decision

Purpose To determine the effectiveness of patient decision aids when used with patients who face cancer-related decisions. Patients and Methods Two reviewers independently screened the 105 trials in the original 2017 Cochrane review to identify eligible trials of patient decision aids across the cancer continuum. Primary outcomes were attributes of the choice and decision-making process. Secondary outcomes were patient behavior and health system effects. A meta-analysis was conducted for similar outcome measures. Results Forty-six trials evaluated patient decision aids for cancer care, including 27 on screening decisions (59%), 12 on treatments (26%), four on genetic testing (9%), and three on prevention (6%). Common decisions were aboutprostate cancer screening (30%), colorectal cancer screening (22%), breast cancer treatment (13%), and prostate cancer treatment (9%). Compared with the control groups (usual care or alternative interventions), the patient decision aid group improved the match between the chosen option and the features that mattered most to the patient as demonstrated by improved knowledge (weighted mean difference, 12.88 of 100; 95% CI, 9.87 to 15.89; 24 trials), accurate risk perception (risk ratio [RR], 1.77; 95% CI, 1.22 to 2.56; six trials), and value-choice agreement (RR, 2.76; 95% CI, 1.57 to 4.84; nine trials). Compared with controls, the patient decision aid group improved the decision-making process with decreased decisional conflict (weighted mean difference, −9.56 of 100; 95% CI, −13.90 to −5.23; 12 trials), reduced clinician-controlled decision making (RR, 0.57; 95% CI, 0.41 to 0.79; eight trials), and fewer patients being indecisive (RR, 0.59; 95% CI, 0.45 to 0.78; nine trials). Conclusion Patient decision aids improve the attributes of the choice made and decision-making process for patients who face cancer-related decisions.

Download Full-text