TOOLS TO PROMOTE SHARED DECISION-MAKING IN LUNG CANCER SCREENING USING LOW-DOSE COMPUTERIZED TOMOGRAPHY: A SYSTEMATIC REVIEW

Abstract

Abstract Background Decisions about lung cancer screening are inherently complex and create a need for methods to convey the risks and benefits of screening to patients. Research Question What kind of decision aids or tools are available to support shared-decision making for lung cancer screening? What is the current evidence for the effectiveness, acceptability and feasibility of those tools? Study Design and Methods: We conducted a systematic review of studies and searched PubMed, MEDLINE, EMBASE, Cochrane Clinical Trials Register and ClinicalTrials.gov from inception to December 2019 for studies that evaluated the effectiveness and acceptability of tools to promote shared decision making for patients considering lung cancer screening. Results After screening 2427 records, we included 1 randomized control trial, 2 observational studies, 11 pre-post studies of a decision aid or an educational tool. Fifteen distinct tools in various formats were evaluated in 14 studies. Most studies were of fair quality. Studies reported improvement in patients' knowledge of lung cancer screening (n=9 studies), but improvements in specific areas of knowledge were inconsistent. Decisional conflict was low or reduced after administration of the tools (n=7 studies). The acceptability of tools was rated as high by patients (n=7 studies) and physicians (n=1 study). LDCT completion rates varied among studies (n=6 studies). Interpretation Evidence from 14 studies suggests that some elements of existing tools for lung cancer screening may help to prepare patients for decision-making by improving knowledge and reducing decisional conflict. Such tools are generally acceptable to patients and providers. Further studies which use consistent measures and reporting methods and assess relevant decisional and clinical outcomes are needed to determine the comparative effectiveness and feasibility of implementation of these tools. Registration PROSPERO 2018 CRD4201874814