Effect of a Patient Decision Aid on Lung Cancer Screening Decision-Making by Persons Who Smoke: A Randomized Clinical Trial

• Published in: JAMA network open 2020-01, Vol.3 (1), p.e1920362-e1920362
• Main Authors: Volk, Robert J, Lowenstein, Lisa M, Leal, Viola B, Escoto, Kamisha H, Cantor, Scott B, Munden, Reginald F, Rabius, Vance A, Bailey, Linda, Cinciripini, Paul M, Lin, Heather, Housten, Ashley J, Luckett, Pamela Graef, Esparza, Angelina, Godoy, Myrna C, Bevers, Therese B
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Clinical trials; Decision making; Decision Support Techniques; Early Detection of Cancer - methods; Early Detection of Cancer - psychology; Female; Humans; Lung cancer; Lung Neoplasms - diagnosis; Male; Mass Screening - psychology; Mass Screening - statistics & numerical data; Medical screening; Middle Aged; Oncology; Online Only; Original Investigation; Patient Participation - psychology; Patient Participation - statistics & numerical data; Smokers - psychology; Smokers - statistics & numerical data; Tobacco; Tomography, X-Ray Computed - psychology; Tomography, X-Ray Computed - statistics & numerical data; United States
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2019.20362

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