Several recent reports have revealed that the percentage of physicians who discussed CT lung screening with patients who smoke was less than 9%, and that such patient-physician consultations were trending downward. And though the U.S. Centers for Medicare and Medicaid Services (CMS) currently mandates shared decision-making with the use of a decision aid, many individuals who meet the eligibility requirements for CT lung screening remain inadequately informed on the test.
For the current study, Robert Volk, PhD, from the University of Texas MD Anderson Cancer Center and colleagues explored the possibility of using a video as a patient decision aid to better inform eligible individuals about CT lung screening. They collaborated with 13 tobacco cessation phone lines (quitlines) to identify callers who qualified for CT lung screening and then to mail the eligible callers either a DVD video about CT lung screening or a printed educational brochure.
The video was less than 10 minutes long and presented information about the CT screening process and eligibility requirements. It also encouraged smokers to consider their values when weighing the potential harms and benefits of screening. The printed brochure covered many of the same topics but in the form of a two-page printout that did not mention individual values.
The researchers followed up with the callers one week after providing the videos and brochures to gauge their understanding of the screening process and their level of confidence in making an informed decision.
Among the 516 callers, a much higher proportion of those who had access to the video reported clearly understanding the harms and benefits of CT lung screening and feeling prepared to decide whether to undergo the test, compared with those who received the brochure.
All of the differences were statistically significant (p < 0.001).
|Videos vs. brochures for CT lung cancer screening
||Standard educational brochure
||Patient decision aid video
|% of smokers who understood the harms and benefits of screening
|% of smokers prepared to make a decision on screening
|% of smokers feeling informed about their choice
Overall, the video proved to be much more effective than the brochure at informing individuals about CT lung screening and facilitating the decision-making process, the researchers found. The findings mirror a previous study that also found videos to be effective in educating patients about CT lung screening.
Though roughly the same percentage of callers from both groups (30% and 37%) decided to undergo CT lung screening six months after receiving the aids and brochures, "the quitline clients who received the decision aid were more assured about what was important to them in making the choice about screening and felt better informed," Volk said in a statement from the university.
The effectiveness of the study has prompted various organizations to fund the nationwide implementation of the researchers' work -- training tobacco quitline staff to identify callers eligible for CT lung screening and then providing them with a decision aid.
"We've demonstrated that this is a very effective way to identify people at risk for lung cancer," Volk said. "There's potential to reach thousands of people who are eligible for screening and already addressing their risk for lung cancer by seeking cessation services."
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