Abstract
BackgroundThe National Lung Screening Trial demonstrated that low-dose computed tomography (LDCT) screening could be an effective way to reduce lung cancer mortality. Informed decision-making in the context of lung cancer screening requires that potential screening subjects accurately recognize their own lung cancer risk, as well as the harms and benefits associated with screening, while taking into account their personal values and preferences.ObjectiveOur objective is to develop a Web-based decision aid in accordance with the qualifying and certification criteria in the International Patient Decision Aid Standards instrument version 4.0 that will assist patients in making informed decisions with regard to lung cancer screening.MethodsIn “alpha” testing, a prototype of the decision aid was tested for usability with 10 potential screening participants in focus groups. Feedback was also sought from public health and health risk communication experts external to the study. Following that, improvements to the prototype were made accordingly, and “beta” testing was done in the form of a quasi-experimental design—a before-after study—with a group of 60 participants. Outcomes tested were knowledge, risk perception of lung cancer and lung cancer screening, decisional conflict, and acceptability of the decision aid as determined by means of a self-administered electronic survey. Focus groups of a subsample of survey participants will be conducted to gain further insight into usability issues.ResultsAlpha testing is completed. Beta testing is currently being carried out. As of 2014 December 7, 60 participants had completed the before-after study. We expect to have results by 2015 January 31. Qualitative data collection and analysis are expected to be completed by 2015 May 31.ConclusionsWe hypothesize that this Web-based, interactive decision aid containing personalized, graphical, and contextual information on the benefits and harms of LDCT screening will increase knowledge, reduce decisional conflict, and improve concordance between patient preferences and the current US Preventive Services Task Force’s screening guidelines.
Highlights
Lung cancer remains the leading cause of cancer death in the United States [1]
The National Lung Screening Trial demonstrated that lung cancer screening with low-dose computed tomography (LDCT) has the potential to significantly reduce lung cancer mortality [2]
On the basis of this and other evidence, the US Preventive Services Task Force (USPSTF) gave a B recommendation for LDCT screening [3,4], the same strength of recommendation associated with mammography screening
Summary
The National Lung Screening Trial demonstrated that lung cancer screening with low-dose computed tomography (LDCT) has the potential to significantly reduce lung cancer mortality [2]. Lung cancer screening presents a challenge, because it is the first population-wide screening modality with eligibility criteria based on age and on a lifestyle behavior (at least 30 pack-years of tobacco use and smoking within the past 15 years). Identifying those at risk and helping them understand the benefits of screening and how to reduce their risk (e.g., tobacco cessation) is paramount for an effective implementation of population-wide lung cancer screening. Informed decision-making in the context of lung cancer screening requires that potential screening subjects accurately recognize their own lung cancer risk, as well as the harms and benefits associated with screening, while taking into account their personal values and preferences
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