Effect of a Patient Decision Aid on Lung Cancer Screening Decision-Making by Persons Who Smoke

Volk, Robert J.; Lowenstein, Lisa M.; Leal, Viola B.; Escoto, Kamisha Hamilton; Cantor, Scott B.; Munden, Reginald F.; Rabius, Vance; Bailey, Linda A.; Cinciripini, Paul M.; Lin, Heather; Housten, Ashley J.; Luckett, Pamela; Espàrza, Angelina; Godoy, Myrna C.B.; Bevers, Therese B.

doi:10.1001/jamanetworkopen.2019.20362

Cited by 48 publications

(29 citation statements)

References 43 publications

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“…Incorporating patient decision aids, which are designed to promote patient understanding and often include pictographs and lay language, can increase patient knowledge, improve the accuracy of risk perceptions, clarify values, and reduce decisional conflict and regret ( 125 ). Individuals from underserved backgrounds report that decision aids are helpful to understand the risks and benefits of LCS and demonstrate improved LCS knowledge after viewing decision aids ( 126 , 127 ). There are provider-facing tools that are emerging to assist providers in better assessing when the decision to undergo LCS is more preference sensitive and whether to simplify the SDM conversation ( 128 ).…”

Section: Resultsmentioning

confidence: 99%

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

136

117

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Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination. Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS. Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS. Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

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Section: Resultsmentioning

confidence: 99%

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

136

117

View full text Add to dashboard Cite

show abstract

“…The essential task, not just in orthopaedics, is to identify the best-suited therapy for an individual patient, as well as to minimise the harm associated with a particular intervention, because even well-established therapeutic interventions have been questioned in the last few decades [14,32]. Several other examples in the literature identify risk factors for various diseases, such as diabetes [33,34], cardiovascular disease [35,36], breast [37,38] and lung [39,40] cancer and many others that are straightforwardly applicable to HT management, as shown in Table 2.…”

Section: Discussionmentioning

confidence: 99%

“…Lung cancer [39,40] Smoking (cigarette, cigar and pipe), second-hand smoking, beta carotene supplements in heavy smokers, alcohol consumption, exposure to chemicals, air pollution TKA reoperation [17] BMI, smoking, low activity, no sports, no long-distance walking Autoimmune diseases [47] Being obese, smoking, unhealthy eating, physical inactivity, exposure to certain infections, certain medications, exposure to toxic agents does not change, but HTs may differ. From this point of view, HTs must depend on (i) correct diagnosis (assessment of the patient's condition), (ii) diagnosis made at the right place and at the right time (a point on an HT), (iii) intervention proposals or lifestyle changes based on precise data obtained through precision medicine and EHR maintenance and (iv) selecting a path to the next point on the trajectory that has a quantifiably lower risk.…”

Section: Discussionmentioning

confidence: 99%

A theoretical model of health management using data-driven decision-making: the future of precision medicine and health

et al. 2021

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Background The burden of chronic and societal diseases is affected by many risk factors that can change over time. The minimalisation of disease-associated risk factors may contribute to long-term health. Therefore, new data-driven health management should be used in clinical decision-making in order to minimise future individual risks of disease and adverse health effects. Methods We aimed to develop a health trajectories (HT) management methodology based on electronic health records (EHR) and analysing overlapping groups of patients who share a similar risk of developing a particular disease or experiencing specific adverse health effects. Formal concept analysis (FCA) was applied to identify and visualise overlapping patient groups, as well as for decision-making. To demonstrate its capabilities, the theoretical model presented uses genuine data from a local total knee arthroplasty (TKA) register (a total of 1885 patients) and shows the influence of step by step changes in five lifestyle factors (BMI, smoking, activity, sports and long-distance walking) on the risk of early reoperation after TKA. Results The theoretical model of HT management demonstrates the potential of using EHR data to make data-driven recommendations to support both patients’ and physicians’ decision-making. The model example developed from the TKA register acts as a clinical decision-making tool, built to show surgeons and patients the likelihood of early reoperation after TKA and how the likelihood changes when factors are modified. The presented data-driven tool suits an individualised approach to health management because it quantifies the impact of various combinations of factors on the early reoperation rate after TKA and shows alternative combinations of factors that may change the reoperation risk. Conclusion This theoretical model introduces future HT management as an understandable way of conceiving patients’ futures with a view to positively (or negatively) changing their behaviour. The model’s ability to influence beneficial health care decision-making to improve patient outcomes should be proved using various real-world data from EHR datasets.

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“…Patient decision aids for LCS have been shown to increase patient knowledge about lung cancer and the potential harms and benefits of screening, and make patients feel more informed and prepared to make LCS decisions 28‐30 . A striking 85% of respondents who identified as family medicine providers did not use LCS decision aids, compared to 47.4% of pulmonary medicine providers.…”

Section: Discussionmentioning

confidence: 99%

Smoking cessation and shared decision‐making practices about lung cancer screening among primary care providers

et al. 2021

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Objective We describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS). Methods Family, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns. Results Of 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p < 0.01). The majority of providers (47, 92%) reported that they engage in informed/shared decision‐making about LCS, although only about one‐third (17, 33%) indicated using a patient decision aid. Pulmonary medicine providers were more likely to use decision aids than providers from internal or family medicine (p < 0.04). Conclusions Within the context of LCS, primary care providers report often having conversations about smoking cessation with their patients who smoke, have no clear preference for type of treatment, and rarely use follow‐up calls or visits pertaining to quitting smoking. While many providers report engaging in shared decision‐making about LCS, few use a decision aid for this conversation.

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Effect of a Patient Decision Aid on Lung Cancer Screening Decision-Making by Persons Who Smoke

Cited by 48 publications

References 43 publications

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

A theoretical model of health management using data-driven decision-making: the future of precision medicine and health

Smoking cessation and shared decision‐making practices about lung cancer screening among primary care providers

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