Assessment of Lung Cancer Screening Program Websites

Abstract

recommends that individuals at high risk for lung cancer consider benefits and harms before pursuing lung cancer screening. Medical centers develop websites for their lung cancer screening programs, but to date little is known about the websites' portrayal of benefits and harms or what next steps they recommend for individuals considering screening.OBJECTIVE To assess the presentation of potential benefits and harms and recommended next steps on lung cancer screening program websites. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional content analysis of 162 lung cancer screening program websites of academic medical centers (n = 81) and state-matched community medical centers (n = 81) that were randomly selected from American College of Radiology lung cancer screening-designated centers was conducted. The study was performed from December 1, 2018, to January 31, 2019. MAIN OUTCOMES AND MEASURESWebsite presentation of screening-associated benefits and harms was the primary outcome. Benefit was defined as any description related to the potential reduction in lung cancer mortality. Harms were based on the US Preventive Services Task Force recommendations and included false positives, false negatives, overdiagnosis, radiation exposure, and incidental findings. The secondary outcome was next steps that are recommended by websites.RESULTS Overall, the 162 lung cancer screening program websites described the potential benefits more frequently than they described any potential harms (159 [98%] vs 78 [48%], P < .01). False-positive findings were the most frequently reported (72 [44%]) potential harm. Community centers were less likely than academic centers to report any potential harm (32 [40%] vs 46 [57%], P = .03), potential harm from radiation (20 [25%] vs 35 [43%], P = .01), and overdiagnosis (0% vs 11 [14%], P < .01). One hundred nineteen websites (73%) did not explicitly recommend that individuals personally consider the potential benefits and harms of screening; community centers were less likely than academic centers to give this recommendation (15 [19%] vs 28 [35%], P = .02). Most institutions (157 [97%]) listed follow-up steps for screening, but few institutions (35 [22%]) recommended that individuals discuss benefits and harms with a health care professional.CONCLUSIONS AND RELEVANCE Information on public-facing websites of US lung cancer screening programs appears to lack balance with respect to portrayal of potential benefits and harms of screening. Important harms, such as overdiagnosis, were commonly ignored in the sites evaluated, and most of the centers did not explicitly guide individuals toward a guideline-recommended, shared decision-making discussion of harms and benefits.

Assessing Information Available for Health Professionals and Potential Participants on Lung Cancer Screening Program Websites: Cross-sectional Study

“…Of the remaining 151 websites, (academic websites: n=76; community websites: n=75; Multimedia Appendix 1 ), 13 academic websites and 26 community websites had URL changes, largely because lung cancer screening information had been mapped to a different section of the website or a new website was built or refreshed (see an example in Multimedia Appendix 2 ). Therefore, of the 151 included websites, 39 website URLs were different from the original URLs reported by Clark and colleagues [ 14 ].…”

“…The research team contacted the authors of a previously published article (Clark et al [ 14 ]) and obtained the list of 162 lung cancer screening program websites of academic centers (n=81) and state-matched community medical centers (n=81). Further detail on how the websites were selected is provided elsewhere [ 14 ].…”

“…A previous review examined these websites for benefits, harms, and recommended next steps for eligible individuals [ 14 ]. Given these websites are from academic and community-based lung cancer screening–designated centers in the United States and may be the first source of eligibility criteria for potential screening participants, our team aimed to assess whether eligibility criteria for potential screening participants were up-to-date on these websites following the latest updates to the USPSTF recommendation.…”

Clinician and Patient Characteristics Associated With Lung Cancer Screening Following a Shared Decision-making Visit

“…Some of the SDM clinicians previously unknown to the patient might have been affiliated with LDCT screening centers, which may be biased toward LDCT. 3 …”

Opportunities and challenges in lung cancer screening implementation: a narrative review

“…Some marketing strategies proven to be effective for LCS programs include hosting community screening days, direct consumer advertisements, educational websites and telephone access lines to facilitate self-referrals (22,23). Development of websites should be conscientious of presenting information that is balanced with regards to the benefits and harms of LCS, as a study evaluating LCS websites found that benefits were discussed twice as frequently as harms (24).…”