Do decision-support tools for lung cancer screening work?

2020 11 11 23 52 7893 Lung Cancer Ct 3d 400

Lung cancer screening (LCS) decision support tools appear to increase patients' understanding of the disease and increase LCS uptake, researchers have found.

"The [lung cancer screening decision support tool we developed] led to greater knowledge and ... uptake [of LCS]," wrote a group led by Marilyn Schapira, MD, of Michael J. Crescenz Veterans Affairs (VA) Medical Center in Philadelphia. The study findings were published August 30 in JAMA Network Open.

Various professional organizations recommend that physicians conduct shared decision-making conversations with patients at risk of lung cancer before the patient begins regular screening with low-dose CT (LDCT). But how best to accomplish this is unclear, Schapira and colleagues noted.

The investigators evaluated the impact of an online lung cancer screening tool called LCSDecTool (used by patients before visiting the clinic) compared to an "attention control" intervention (an online, 10-page guide that addressed the topic of cancer prevention and outlined screening guidelines) on both the quality of decision-making conversations and screening uptake. The LCSDecTool included an overview of lung cancer screening, a pictograph with LCS outcomes, smoking cessation advice, mental health resources, and the option to request a referral to smoking cessation support resources.

The group conducted a study that enrolled 140 individuals from Veteran Affairs medical centers in Philadelphia, PA; Milwaukee, WI; and West Haven, CT between March 2019 and September 2021. Patients were between the ages of 55 to 80, had smoking histories of at least 30 pack-years and were current smokers, or had quit smoking within the past 15 years. Of 137 participants with racial/ethnic data available, 53.6% were Black, 44.3% were white, and 2.9% were Latino. The team tracked patients' disease status through July 2022.

The primary outcome of the study was assessment of patients' continuing "decisional conflict" (i.e., uncertainty) about whether to undergo LCS at one month after intervention. Secondary outcomes were an assessment of this uncertainty immediately and three months after intervention; knowledge about lung cancer, decisional regret, and anxiety immediately and one to three months after intervention; and decisional regret six months after undergoing screening.

The researchers found that the mean decisional conflict score at one-month post intervention did not differ between the LCSDecTool group and the control group. But they also found the following:

Comparison of lung cancer screening tool performance
Measure Control group LCSDecTool group p-value
Mean lung cancer screening knowledge score* immediately after intervention 4.9 7 < 0.001
Mean lung cancer screening knowledge score at 1-month follow-up 5.2 6.3 0.03
Mean lung cancer screening knowledge score at 3-month follow-up 5.1 6.2 0.01
Lung cancer screening uptake at 6 months post intervention 21.1% 37.7% 0.04
*Scale of 0 to 8, with larger numbers equal to higher health literacy

"Analysis of secondary outcomes suggests that the [LCSDecTool] intervention improved LCS knowledge without increasing general anxiety or lung cancer worry," the group noted.

The group hopes the study results will contribute to further refinement of lung cancer screening advocacy strategies.

"These findings can inform future implementation strategies and research in LCS shared decision-making," the authors concluded.

The complete study can be found here.

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