Abstract
Lung cancer screening with low-dose computed tomography lowers lung cancer mortality but has potential harms. Current guidelines support patients receiving information about the benefits and harms of lung cancer screening during decision-making. To examine the effect of a patient decision aid (PDA) about lung cancer screening compared with a standard educational material (EDU) on decision-making outcomes among smokers. This randomized clinical trial was conducted using 13 state tobacco quitlines. Current and recent tobacco quitline clients who met age and smoking history eligibility for lung cancer screening were enrolled from March 30, 2015, to September 12, 2016, and followed up for 6 months until May 5, 2017. Data analysis was conducted between May 5, 2017, and September 30, 2018. Participants were randomized to the PDA video Lung Cancer Screening: Is It Right for Me? (n = 259) or to EDU (n = 257). The primary outcomes were preparation for decision-making and decisional conflict measured at 1 week. Secondary outcomes included knowledge, intentions, and completion of screening within 6 months of receiving the intervention measured by patient report. Of 516 quit line clients enrolled, 370 (71.7%) were younger than 65 years, 320 (62.0%) were female, 138 (26.7%) identified as black, 47 (9.1%) did not have health insurance, and 226 (43.8%) had a high school or lower educational level. Of participants using the PDA, 153 of 227 (67.4%) were well prepared to make a screening decision compared with 108 of 224 participants (48.2%) using EDU (odds ratio [OR], 2.31; 95% CI, 1.56-3.44; P < .001). Feeling informed about their screening choice was reported by 117 of 234 participants (50.0%) using a PDA compared with 66 of 233 participants (28.3%) using EDU (OR, 2.56; 95% CI, 1.72-3.79; P < .001); 159 of 234 participants (68.0%) using a PDA compared with 110 of 232 (47.4%) participants using EDU reported being clear about their values related to the harms and benefits of screening (OR, 2.37; 95% CI, 1.60-3.51; P < .001). Participants using a PDA were more knowledgeable about lung cancer screening than participants using EDU at each follow-up assessment. Intentions to be screened and screening behaviors did not differ between groups. In this study, a PDA delivered to clients of tobacco quit lines improved informed decision-making about lung cancer screening. Many smokers eligible for lung cancer screening can be reached through tobacco quit lines. ClinicalTrials.gov identifier: NCT02286713.
Highlights
Lung cancer is the leading cause of death from cancer in the United States, and smoking is the most important risk factor for developing and dying of lung cancer.[1,2] The National Lung Screening Trial[3] found 20% fewer lung cancer deaths among current and former heavy smokers screened using low-dose computed tomography (LDCT) compared with those screened with standard chest radiography.[3]
Feeling informed about their screening choice was reported by 117 of 234 participants (50.0%) using a patient decision aid (PDA) compared with 66 of 233 participants (28.3%) using educational material (EDU) (OR, 2.56; 95% CI, 1.72-3.79; P < .001); 159 of 234 participants (68.0%) using a PDA compared with 110 of 232 (47.4%) participants using EDU reported being clear about their values related to the harms and benefits of screening (OR, 2.37; 95% CI, 1.60-3.51; P < .001)
In this study, a PDA delivered to clients of tobacco quit lines improved informed decision-making about lung cancer screening
Summary
Lung cancer is the leading cause of death from cancer in the United States, and smoking is the most important risk factor for developing and dying of lung cancer.[1,2] The National Lung Screening Trial[3] found 20% fewer lung cancer deaths among current and former heavy smokers screened using low-dose computed tomography (LDCT) compared with those screened with standard chest radiography.[3] screening rates nationally remain low.[4] In addition, lung cancer screening with LDCT is not without risks, including radiation exposure from screening and diagnostic imaging and a high false-positive rate leading to subsequent testing, which is associated with harms.[5,6]. There is a need for PDAs to support informed decision-making about lung cancer screening using LDCT, yet few tools have been developed and none have been evaluated in comparative trials.[16]
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