February 04, 2020
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Patient decision aid improves informed decision making about lung cancer screening

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A video patient decision aid delivered to tobacco quit line clients led to more informed decision making about lung cancer screening, according to data published in JAMA Network Open.

For the trial, researchers enrolled 516 participants aged 55 to 77 years with a 30-plus pack-year smoking history who called into one of 13 tobacco quit lines. They then randomly assigned participants to receive the patient decision aid — a 9.5-minute narrated video titled Lung Cancer Screening: Is It Right for Me? (n = 259) — or standard educational materials in the form of a -page brochure from a lung cancer advisory group (n = 257).

Of the patients enrolled, 71.7% were aged younger than 65 years, 62% were women and 26.7% identified as black. Approximately 9% were uninsured and 43.8% had a high school education level or less.

The study’s primary outcomes were preparation for decision making and decisional conflict measured by the Decisional Conflict Scale.

More informed decisions

At 1-week follow-up, 67.4% of participants who received the patient decision aid were well prepared to make a decision on lung cancer screening, compared with 48.2% of those who received standard educational materials (OR = 2.31; 95% CI, 156-3.44). Additionally, compared with the standard educational materials group, the patient decision aid group appeared more likely to report feeling informed about their decision choice (50% vs. 28.3%; OR = 2.56; 95% CI, 1.72-3.79) and were more likely to report being clear about their values related to the benefits and harms lung cancer screening (68% vs. 47.4%; OR = 2.37; 95% CI, 1.6-3.51).

A video patient decision aid delivered to tobacco quit line clients led to more informed decision making about lung cancer screening, according to data published in JAMA Network Open.
Source: Adobe Stock

“The quit line 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,” Robert Volk, PhD, professor of health services research at The University of Texas MD Anderson Cancer Center, said in a press release. “Their knowledge of the harms and benefits of screening was much greater than people who received standard educational information. The clients in the control group were making screening choices while being less prepared and aware of the trade-offs between benefit and harms. We want to head off the uninformed choice and help patients make good, informed decisions about screening.”

Participants who received the patient decision aid also demonstrated greater lung cancer screening knowledge than those who received standard educational materials at 1 week, 3 months and 6 months. Knowledge was highest at 1 week in the patient decision aid group and declined at each subsequent follow-up. Knowledge also declined between 1 week and 3 months in the standard educational materials group, but there was no significant difference in knowledge at 3- and 6-month follow-up assessments.

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Also at 6 months, fewer participants in the patient decision aid group than in the standard education group had scheduled screening, but the difference was not statistically significant.

Implications

The patient decision aid video included information on lung cancer screening eligibility and calculation of tobacco pack-year smoking history, lung cancer epidemiology and risk factors, a video of a patient in a CT scanner, graphic depictions of the magnitude of mortality reduction, false-positive results and harms from invasive diagnostic procedures and radiation exposure. The standard educational brochure included structured questions a patient can ask a physician about lung cancer screening, including eligibility for screening, harms and benefits, costs, what to expect from undergoing a low-dose CT scan, how to interpret low-dose CT results, the importance of smoking cessation and where to find more information about lung cancer and lung cancer screening.

Disseminating this information to people using tobacco quit lines may be a helpful way to increase lung cancer screening rates, the researchers noted.

"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."

The researchers noted, however, that the study was not without limitations, including reliance on self-report and the fact that those who called into the quit line had to express an interest in lung cancer screening when asked by the quit line staff. – by Melissa Foster

Disclosure: Volk reports he has received research support from the Patient-Centered Outcomes Research Institute (PCORI) and grants from the NIH and University of Texas MD Anderson Cancer Center. Please see the study for all other authors’ relevant financial disclosures.