Patient Decision Aid Leads to Improved Decision-Making About Lung Cancer Screening

A patient decision aid (PDA) delivered to clients of tobacco quit lines improved informed decision-making about lung cancer screening, according to a study published in JAMA Network Open. 

Researchers noted that many smokers eligible for lung cancer screening can be reached through tobacco quit lines. 

“Carefully addressing the role of tobacco quit lines in distributing PDA support for lung cancer screening, given variable quit line funding, is necessary for broader dissemination and greater effect of the intervention,” the authors wrote. 

Across 13 state tobacco quit lines, researchers enrolled 516 quit line clients who were randomized to the PDA video Lung Cancer Screening: Is it Right for Me? (n = 259) or to standard educational material (EDU; n = 257). Of those who used the PDA, 153 of 227 (67.4%) were well prepared to make a screening decision compared to 108 of 224 participants (48.2%) using EDU (odds ratio [OR], 2.31; 95% CI, 1.56-3.44; P < 0.001). 

A feeling of being informed about their screening choice was reported by 117 of 234 participants (50%) using a PDA compared with 66 of 233 participants (28.3%) using EDU (OR, 2.56; 95% CI, 1.72-3.79; P < 0.001). Moreover, 159 of 234 participants (68%) using a PDA expressed being sure about their values relative to the harms and benefits of screening compared to 110 of 232 (47.4%) participants using EDU. 

Those who used a PDA were found to be more knowledgeable about lung cancer screening than participants using EDU at each follow-up assessment. Intentions to be screened and screening behaviors were not varied between the two groups. 

“Of interest, approximately 1 in 4 participants wanted more information from the PDA,” the authors wrote. “This highlights the importance of a conversation with a health care clinician to probe patients’ information needs and misconceptions related to lung cancer screening.” 

Notably, screening rates in this study were higher than national estimates but were lower than screening rates among referred patients in the pulmonary care setting, though few studies have looked into this issue. Researchers indicated that though some differences were observed in screening intentions and behaviors between the PDA and EDU participant groups, future research is necessary to clarify the effect of PDAs on lung cancer screening behaviors.

“We would not necessarily expect a PDA to affect screening rates because enthusiasm for cancer screening in general is high,” the authors wrote. “Our findings suggest that targeting smokers who are already motivated to quit smoking is an effective approach to increasing screening rates.” 

According to the study, The National Lung Screening Trial found 20% fewer lung cancer deaths among current and former heavy smokers screened using low-dose computed tomography compared to those screened with standard chest radiography. However, on a national level, screening rates continually remain low. Additionally, screening with LDCT comes with risks, including radiation exposure from screening and diagnostic imaging and a high false-positive rate leading to subsequent testing, which is also correlated with harms. 

Reference:

Volk RJ, Lowenstein LM, Leal VB, et al. Effect of a Patient Decision Aid on Lung Cancer Screening Decision-Making by Persons Who Smoke. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.20362.