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- Title
Lung Cancer Screening Decision Aid Designed for a Primary Care Setting: A Randomized Clinical Trial.
- Authors
Schapira, Marilyn M.; Hubbard, Rebecca A.; Whittle, Jeff; Vachani, Anil; Kaminstein, Dana; Chhatre, Sumedha; Rodriguez, Keri L.; Bastian, Lori A.; Kravetz, Jeffrey D.; Asan, Onur; Prigge, Jason M.; Meline, Jessica; Schrand, Susan; Ibarra, Jennifer V.; Dye, Deborah A.; Rieder, Julie B.; Frempong, Jemimah O.; Fraenkel, Liana
- Abstract
Key Points: Question: Can a lung cancer screening (LCS) decision tool designed for use in a primary care clinical setting improve informed LCS decision-making? Findings: In this randomized clinical trial of 140 participants, no statistically significant difference in decisional conflict was found at 1 month after intervention (25.7 vs 29.9, on a scale of 0 [none] to 100 [high]). Analysis of secondary outcomes suggests that the LCS decision tool intervention improved LCS knowledge without increasing general anxiety or lung cancer worry. Meaning: This patient decision aid designed for use in a primary care setting can inform future research to advance LCS shared decision-making interventions. This randomized clinical trial evaluates the efficacy of a web-based patient- and clinician-facing lung cancer screening patient decision aid compared with an attention control intervention on the quality of decision-making and uptake of lung cancer screening in a population of Veterans Affairs patients. Importance: Guidelines recommend shared decision-making prior to initiating lung cancer screening (LCS). However, evidence is lacking on how to best implement shared decision-making in clinical practice. Objective: To evaluate the impact of an LCS Decision Tool (LCSDecTool) on the quality of decision-making and LCS uptake. Design, Setting, and Participants: This randomized clinical trial enrolled participants at Veteran Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut, from March 18, 2019, to September 29, 2021, with follow-up through July 18, 2022. Individuals aged 55 to 80 years with a smoking history of at least 30 pack-years who were current smokers or had quit within the past 15 years were eligible to participate. Individuals with LCS within 15 months were excluded. Of 1047 individuals who were sent a recruitment letter or had referred themselves, 140 were enrolled. Intervention: A web-based patient- and clinician-facing LCS decision support tool vs an attention control intervention. Main Outcome and Measures: The primary outcome was decisional conflict at 1 month. Secondary outcomes included decisional conflict immediately after intervention and 3 months after intervention, knowledge, decisional regret, and anxiety immediately after intervention and 1 and 3 months after intervention and LCS by 6 months. Results: Of 140 enrolled participants (median age, 64.0 [IQR, 61.0-69.0] years), 129 (92.1%) were men and 11 (7.9%) were women. Of 137 participants with data available, 75 (53.6%) were African American or Black and 62 (44.3%) were White; 4 participants (2.9%) also reported Hispanic or Latino ethnicity. Mean decisional conflict score at 1 month did not differ between the LCSDecTool and control groups (25.7 [95% CI, 21.4-30.1] vs 29.9 [95% CI, 25.6-34.2], respectively; P =.18). Mean LCS knowledge score was greater in the LCSDecTool group immediately after intervention (7.0 [95% CI, 6.3-7.7] vs 4.9 [95% CI, 4.3-5.5]; P <.001) and remained higher at 1 month (6.3 [95% CI, 5.7-6.8] vs 5.2 [95% CI, 4.5-5.8]; P =.03) and 3 months (6.2 [95% CI, 5.6-6.8] vs 5.1 [95% CI, 4.4-5.8]; P =.01). Uptake of LCS was greater in the LCSDecTool group at 6 months (26 of 69 [37.7%] vs 15 of 71 [21.1%]; P =.04). Conclusions and Relevance: In this randomized clinical trial of an LCSDecTool compared with attention control, no effect on decisional conflict occurred at 1 month. The LCSDecTool used in the primary care setting did not yield a significant difference in decisional conflict. The intervention led to greater knowledge and LCS uptake. These findings can inform future implementation strategies and research in LCS shared decision-making. Trial Registration: ClinicalTrials.gov Identifier: NCT02899754
- Subjects
UNITED States; RESEARCH; CONFIDENCE intervals; LUNG tumors; EARLY detection of cancer; PRIMARY health care; RANDOMIZED controlled trials; DECISION making; DESCRIPTIVE statistics; RESEARCH funding; DECISION making in clinical medicine; STATISTICAL sampling; LOGISTIC regression analysis; SMOKING; ANXIETY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2330452
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.30452