Development and Patient Usability Analysis of a Veteran Centric Web-based Decision Aid for Lung Cancer Screening (Preprint)

2021 ◽  
Author(s):  
Marilyn Schapira ◽  
Sumedha Chhatre ◽  
Jason Prigge ◽  
Jessica Meline ◽  
Dana Kaminstein ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Cancer Screening ◽  
Medical Center ◽  
Clinical Care ◽  
Lung Cancer Screening ◽  
Potential Range ◽  
Medical Terminology ◽  
Web Based ◽  
System Usability Scale

BACKGROUND Web based tools developed to facilitate a Shared Decision Making (SDM) process may facilitate implementation of lung cancer screening (LCS), an evidence based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that impact the benefit and potential harms of LCS, so may value a Veteran centric LCS SDM too OBJECTIVE To develop and conduct usability testing of a LCS Decision Tool (LCSDecTool) designed for Veterans receiving care at a Veteran Affairs Medical Center (VAMC). METHODS A user-centered design approach was undertaken to develop the LCSDecTool. Usability of a prototype was assessed among 18 Veterans from two VA sites. Usability of a high fidelity version was assessed among 43 Veterans as part of a clinical trial. Outcomes included the System Usability Scale (SUS), the End User Computer Satisfaction (EUCS), and the Patient Engagement (PE) scale. Qualitative data from observations and short interviews with users were analyzed and themes pertaining to usability identified. RESULTS The mean (SD) in the pilot clinical trial (n=43) for the SUS (potential range 0 [low] to 100 [high] was 65.76 [15.23]); EUCS (potential range 1 [low] to 5 [high] was 3.91 [0.95]); and PE (potential range 1[low) to 5 [high] was 4.62 [0.67]). Time to completion of the LCSDecTool in minutes (median, intra-quartile range) was (13, 10-16). Emerging themes included: 1) a baseline gap in awareness of LCS with knowledge gained from using the LCSDecTool, 2) an interest in details about the LCS process, 3) the LCSDecTool was easy to use overall but specific navigation challenges identified, and 4) difficulty in understanding medical terminology. CONCLUSIONS The LCSDecTool demonstrates a good level of usability among Veterans when testing in the context of clinical care. Study findings will inform further modifications of the tool, including shortening the length and simplifying language. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT02899754

scholarly journals Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

2021 ◽  
Author(s):  
Christopher J Cadham ◽  
Pianpian Cao ◽  
Jinani Jayasekera ◽  
Kathryn L Taylor ◽  
David T Levy ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Cancer Registries ◽  
Web Based ◽  
Screening Programs ◽  
Life Years

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.

Improving lung cancer diagnosis at a large urban minority-based medical center: Where can we do better?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18017-e18017
Author(s):  
Christopher Su ◽  
Vincent Chau ◽  
Amit Bhargava ◽  
Chirag D Shah ◽  
Nitin Ohri ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Diagnosis ◽  
Capita Income ◽  
Medical Center ◽  
Lung Cancer Screening ◽  
Advanced Stage ◽  
Lung Cancer Diagnosis ◽  
Significant Difference ◽  
Per Capita

e18017 Background: Lung cancer diagnosis is a complex process with barriers to care which are more apparent in underserved communities. We examined factors affecting lung cancer diagnosis in an underserved urban community, including demographics, lung cancer screening, and survival outcomes. Methods: All new lung cancer diagnoses with confirmed pathology at an urban academic medical center in 2015 were identified. Retrospective chart review was conducted and time from initial abnormal imaging to tissue sampling was calculated. Analyses were performed with χ2, ANOVA, linear regression, and log-rank tests. Results: In 2015, 229 patients were diagnosed with lung cancer. 36 patients (16%) expired or were referred to hospice due to clinical deterioration without treatment. 162 patients (71%) were ultimately started on therapy. Patients were predominantly Black (38%), Hispanic (30%), underserved (mean per capita income $21729), and enrolled in Medicare or Medicaid (83%). Only 62% of the patients had a PCP at time of diagnosis. Most presented at an advanced stage (63% III or IV) and 88% were former/current smokers. 78 patients (48%) were eligible for low-dose CT screening but only 9 (12%) completed screening. Screening completion was correlated with established PCP (p = 0.012). Time from abnormal imaging to biopsy was 31±40 days without significant difference across age, gender, race, ethnicity, income, insurance, and primary language. Cancers diagnosed in the inpatient vs. outpatient setting were found at a more advanced stage (p = 0.002) and had lower survival (p < 0.001). Hispanics had better survival (p = 0.008) despite lower per capita income and higher incidence of smoking. Conclusions: There was no significant difference in imaging to biopsy time across major demographic factors and they are unlikely to be a source of poor outcomes. However, the advanced stage and poor prognosis of cancers detected in the inpatient setting, proportion of patients who expired or were referred to hospice immediately after presentation, and disparity between screening eligible and completed patients underscores the critical importance of increasing lung cancer screening and establishment of primary care.

scholarly journals Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial

2017 ◽  
Vol 60 ◽  
pp. 78-85 ◽  
Author(s):  
David E. Gerber ◽  
Heidi A. Hamann ◽  
Noel O. Santini ◽  
Suhny Abbara ◽  
Hsienchang Chiu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Trial ◽  
Cancer Screening ◽  
Randomized Clinical Trial ◽  
Patient Navigation ◽  
Lung Cancer Screening ◽  
Safety Net ◽  
Urban Safety

When Is a Harm a Harm? Discordance between Patient and Medical Experts’ Evaluation of Lung Cancer Screening Attributes

2021 ◽  
Vol 41 (3) ◽  
pp. 317-328
Author(s):  
Marilyn M. Schapira ◽  
Keri L. Rodriguez ◽  
Sumedha Chhatre ◽  
Liana Fraenkel ◽  
Lori A. Bastian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Radiation Exposure ◽  
Incidental Findings ◽  
Medical Center ◽  
Indirect Costs ◽  
Lung Cancer Screening ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Semistructured Interviews

Background A shared decision-making (SDM) process for lung cancer screening (LCS) includes a discussion between clinicians and patients about benefits and potential harms. Expert-driven taxonomies consider mortality reduction a benefit and consider false-positives, incidental findings, overdiagnosis, overtreatment, radiation exposure, and direct and indirect costs of LCS as potential harms. Objective To explore whether patients conceptualize the attributes of LCS differently from expert-driven taxonomies. Design Cross-sectional study with semistructured interviews and a card-sort activity. Participants Twenty-three Veterans receiving primary care at a Veterans Affairs Medical Center, 55 to 73 y of age with 30 or more pack-years of smoking. Sixty-one percent were non-Hispanic African American or Black, 35% were non-Hispanic White, 4% were Hispanic, and 9% were female. Approach Semistructured interviews with thematic coding. Main Measures The proportion of participants categorizing each attribute as a benefit or harm and emergent themes that informed this categorization. Key Results In addition to categorizing reduced lung cancer deaths as a benefit (22/23), most also categorized the following as benefits: routine annual screening (8/9), significant incidental findings (20/23), follow-up in a nodule clinic (20/23), and invasive procedures (16/23). Four attributes were classified by most participants as a harm: false-positive (13/22), overdiagnosis (13/23), overtreatment (6/9), and radiation exposure (20/22). Themes regarding the evaluation of LCS outcomes were 1) the value of knowledge about body and health, 2) anticipated positive and negative emotions, 3) lack of clarity in terminology, 4) underlying beliefs about cancer, and 5) risk assessment and tolerance for uncertainty. Conclusions Anticipating discordance between patient- and expert-driven taxonomies of the benefits and harms of LCS can inform the development and interpretation of value elicitation and SDM discussions.

scholarly journals Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers

2021 ◽  
Vol 9 ◽  
Author(s):  
Chien-Ching Li ◽  
Alicia K. Matthews ◽  
Yu-Hsiang Kao ◽  
Wei-Ting Lin ◽  
Jad Bahhur ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Access To Care ◽  
Smoking Status ◽  
Medical Center ◽  
Academic Medical Center ◽  
Lung Cancer Screening ◽  
Service Area ◽  
Smoking History ◽  
Study Results

Objective: The purpose of this study was to examine the influence of access to care on the uptake of low-dose computed tomography (LDCT) lung cancer screening among a diverse sample of screening-eligible patients.Methods: We utilized a cross-sectional study design. Our sample included patients evaluated for lung cancer screening at a large academic medical center (AMC) between 2015 and 2017 who met 2013 USPSTF guidelines for LDCT screening eligibility. The completion of LDCT screening (yes, no) was the primary dependent variable. The independent variable was access to care (insurance type, living within the AMC service area). We utilized binary logistic regression analyses to examine the influence of access to care on screening completion after adjusting for demographic factors (age, sex, race) and smoking history (current smoking status, smoking pack-year history).Results: A total of 1,355 individuals met LDCT eligibility criteria, and of those, 29.8% (n = 404) completed screening. Regression analysis results showed individuals with Medicaid insurance (OR, 1.51; 95% CI, 1.03-2.22), individuals living within the AMC service area (OR, 1.71; 95% CI, 1.21–2.40), and those aged 65–74 years (OR, 1.49; 95% CI, 1.12–1.98) had higher odds of receiving LDCT lung cancer screening. Lower odds of screening were associated with having Medicare insurance (OR, 0.30; 95% CI, 0.22–0.41) and out-of-pocket (OR, 0.27; 95% CI, 0.15–0.47).Conclusion: Access to care was independently associated with lowered screening rates. Study results are consistent with prior research identifying the importance of access factors on uptake of cancer early detection screening behaviors.

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