A Patient decision aid to help heavy smokers make decisions about lung cancer screening / Robert J. Volk.

Format:

Book

Author/Creator:

Volk, Robert J., author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Decision Support Techniques.

Physical Description:

1 online resource (58 pages) : illustrations.

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute, 2019.

Summary:

BACKGROUND: Screening for lung cancer with low-dose computed tomography is recommended by the US Preventive Services Task Force with a Grade B and is reimbursed by the Centers for Medicare & Medicaid Services (CMS). Reimbursement by CMS requires use of a patient decision aid to support shared decision-making before screening. Effective strategies are needed that provide high-quality decision support to patients eligible for lung cancer screening (LCS). OBJECTIVES: We conducted a randomized controlled trial of a video patient decision aid, "Lung Cancer Screening: Is It Right for Me?" The aim of this study was to compare decision-making outcomes about LCS among patients recruited through state-based tobacco quitlines, where patients were randomly assigned to the decision aid or to standard educational materials about LCS. METHODS: Quitlines referred patients aged 55 to 77 years to the project. After screening for eligibility, patients were randomized, stratified by state of origin, to the study groups. We assessed the primary outcomes (Preparation for Decision Making Scale and Informed and Values Clarity subscales of the Decisional Conflict Scale) after 1 week. We assessed knowledge of LCS at each follow-up period; we assessed screening intentions and behaviors at 3-month and 6-month follow-ups. We explored interactions between intervention group and race of the patient. RESULTS: Thirteen state quitlines contributed 516 patients to the study. Follow-up rates at the 1-week, 3-month, and 6-month assessments were 90.7%, 87.6%, and 85.9%, respectively. Among the patients, 370 (71.7%) were under 65 years of age, 320 (62.0%) were female, 138 (26.7%) identified as Black or African American, 47 (9.1%) had no health insurance, and 226 (43.8%) had a high school education or less. At the 1-week follow-up, patients who received the decision aid, compared with those who received the standard education materials, were more prepared to make a screening decision (decision aid patients, mean, 79.4; 95% CI, 77.1-81.7; standard education patients, mean, 69.4; 95% CI, 66.4-72.4; P < .0001), felt more informed about the screening options (decision aid patients, mean 27.1; 95% CI, 23.8-30.5; standard education patients, mean, 42.1; 95% CI, 38.0-45.9; P < .0001 [lower scores indicate better outcomes]), and were clearer about their values related to the harms and benefits of screening (decision aid patients, mean 17.6; 95% CI, 14.2-21.0; standard education patients, mean, 31.7; 95% CI, 27.3-35.8; P < .0001 [lower scores indicate better outcomes]). They were more knowledgeable than patients assigned to the standard education materials at each follow-up assessment (P < .0001). Intentions to be screened and scheduling a doctor's visit to discuss screening did not differ between groups. We observed no significant interactions of the intervention group and race of the patient. STUDY LIMITATIONS: We collected data using patient self-reports. We were not able to collect and verify information about screening results and subsequent testing because the follow-up period was too short. We don't know the reasons some patients were not interested in screening or participating in the study. For patients who had a visit to discuss LCS, we do not have information about the quality of the decision-making process with the health care provider. CONCLUSIONS: A decision aid delivered to patients of tobacco quitlines improved readiness to discuss LCS with a physician, reduced decisional conflict, and improved knowledge, when compared with standard education materials. The potential to reach large numbers of smokers through quitlines is great but would require carefully addressing the role of quitlines in dissemination, given their limited funding.

Contents:

Background

Participation of Patients and Other Stakeholders in the Study Planning and Design, Conduct of Research, and Dissemination of Findings

Methods

Results

Discussion

Conclusions

References

Related Publications

Acknowledgments

Appendices.

Notes:

Description based on publisher supplied metadata and other sources.