Feasibility of a patient decision aid about lung cancer screening with low-dose computed tomography

Abstract

Objective New clinical guidelines endorse the use of low-dose computed tomography (LDCT) for lung cancer screening among selected heavy smokers while recommending patients be counseled about the potential benefits and harms. We developed and field tested a brief, video-based patient decision aid about lung cancer screening. Methods Smokers in a cancer center tobacco treatment program aged 45 to 75 years viewed the video online between November 2011 and September 2012. Acceptability, knowledge, and clarity of values related to the decision were assessed. Results Fifty-two patients completed the study (mean age=58.5 years; mean duration smoking=34.8 years). Acceptability of the aid was high. Most patients (78.8%) indicated greater interest in screening after viewing the aid. Knowledge about lung cancer screening increased significantly as a result of viewing the aid (25.5% of questions answered correctly before the aid, and 74.8% after; P<.01) although understanding of screening eligibility remained poor. Patients reported being clear about which benefits and harms of screening mattered most to them (94.1% and 86.5%, respectively). Conclusions Patients have high information needs related to lung cancer screening. A video-based decision aid may be helpful in promoting informed decision-making, but its impact on lung cancer screening decisions needs to be explored.

An Official American Thoracic Society/American College of Chest Physicians Policy Statement: Implementation of Low-Dose Computed Tomography Lung Cancer Screening Programs in Clinical Practice

“…Clinicians should be well-versed in the benefits and harms of LDCT screening (Table 1) and how trade-offs vary depending on the patient's personal risk profile and comorbidities (24,26). Important elements to include in a conversation before a screening decision is made (32) are that nodules are commonly found (approximately 25-50% of screening examinations [33]), that most (z95%) nodules detected by screening are benign (1), and that the detection of a lung nodule and its subsequent evaluation may cause distress, physical complications, or other harms (17,(39)(40)(41)(42)(43)(44).…”

“…It is reasonable to supplement verbal discussions with plain language materials (21,24,25) or video decision aids (42) the patient can review at home. Of note, these tools are still undergoing testing (42,43), and the best format for decision tools remains unclear (44). Standardizing several elements can improve quality of care in LDCT screening programs (19).…”

Evaluation of a Personalized, Web-Based Decision Aid for Lung Cancer Screening

“…To the authors’ knowledge, only one DA has been peer-reviewed to date. 7 Moreover, current DAs 7–11 do not consider individual characteristics and only provide average risks and benefits of LCS. Precise risk prediction should be a critical part of LCS because clinically important differences in benefit exist even among screen-eligible individuals.…”

Challenges With Identifying Indication for Examination in Breast Imaging as a Key Clinical Attribute in Practice, Research, and Policy

“…(29, 30) (31–33) Singal et al addressed the challenges of defining indication, as screening, surveillance or diagnostic, given misclassification and ascertaining indication in colonoscopy. (34) Colonoscopy has an additional indication category of surveillance for which colonoscopy quality indicators for screening differ from surveillance.…”