A pre-post study testing a lung cancer screening decision aid in primary care
Abstract Background The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medica...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-01-01
|
| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-018-0582-1 |
| _version_ | 1818277978493157376 |
|---|---|
| author | Daniel S. Reuland Laura Cubillos Alison T. Brenner Russell P. Harris Bailey Minish Michael P. Pignone |
| author_facet | Daniel S. Reuland Laura Cubillos Alison T. Brenner Russell P. Harris Bailey Minish Michael P. Pignone |
| author_sort | Daniel S. Reuland |
| collection | DOAJ |
| description | Abstract Background The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medicaid Services require shared decision making using a decision aid for lung cancer screening with annual LDCT. Little is known about how decision aids affect screening knowledge, preferences, and behavior. Thus, we tested a lung cancer screening decision aid video in screening-eligible primary care patients. Methods We conducted a single-group study with surveys before and after decision aid viewing and medical record review at 3 months. Participants were active patients of a large US academic primary care practice who were current or former smokers, ages 55–80 years, and eligible for screening based on current screening guidelines. Outcomes assessed pre-post decision aid viewing were screening-related knowledge score (9 items about screening-related harms of false positives and overdiagnosis, likelihood of benefit; score range = 0–9) and preference (preferred screening vs. not). Screening behavior measures, assessed via chart review, included provider visits, screening discussion, LDCT ordering, and LDCT completion within 3 months. Results Among 50 participants, knowledge increased from pre- to post-decision aid viewing (mean = 2.6 vs. 5.5, difference = 2.8; 95% CI 2.1, 3.6, p < 0.001). Preferences across the overall sample remained similar such that 54% preferred screening at baseline and 50% after viewing; however, 28% of participants changed their preference (to or away from screening) from baseline to after viewing. We assessed screening behavior for 36 participants who had a primary care visit during the 3-month period following enrollment. Eighteen of 36 preferred screening after decision aid viewing. Of these 18, 10 discussed screening, 8 had a test ordered, and 6 completed LDCT. Among the 18 who preferred no screening, 7 discussed screening, 5 had a test ordered, and 4 completed LDCT. Conclusions In primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous. Trial registration This study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016). |
| first_indexed | 2024-12-12T23:10:08Z |
| format | Article |
| id | doaj.art-4f4b3229c49040ab9048d65cc7b9e401 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-12T23:10:08Z |
| publishDate | 2018-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-4f4b3229c49040ab9048d65cc7b9e4012022-12-22T00:08:37ZengBMCBMC Medical Informatics and Decision Making1472-69472018-01-011811910.1186/s12911-018-0582-1A pre-post study testing a lung cancer screening decision aid in primary careDaniel S. Reuland0Laura Cubillos1Alison T. Brenner2Russell P. Harris3Bailey Minish4Michael P. Pignone5Department of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel HillLineberger Comprehensive Cancer Center, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel HillLineberger Comprehensive Cancer Center, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel HillDepartment of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel HillDepartment of General Medicine and Clinical Epidemiology, University of North Carolina, School of Medicine, Ambulatory Care Center, University of North Carolina at Chapel HillDepartment of Medicine, Dell Medical School, The University of Texas at AustinAbstract Background The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medicaid Services require shared decision making using a decision aid for lung cancer screening with annual LDCT. Little is known about how decision aids affect screening knowledge, preferences, and behavior. Thus, we tested a lung cancer screening decision aid video in screening-eligible primary care patients. Methods We conducted a single-group study with surveys before and after decision aid viewing and medical record review at 3 months. Participants were active patients of a large US academic primary care practice who were current or former smokers, ages 55–80 years, and eligible for screening based on current screening guidelines. Outcomes assessed pre-post decision aid viewing were screening-related knowledge score (9 items about screening-related harms of false positives and overdiagnosis, likelihood of benefit; score range = 0–9) and preference (preferred screening vs. not). Screening behavior measures, assessed via chart review, included provider visits, screening discussion, LDCT ordering, and LDCT completion within 3 months. Results Among 50 participants, knowledge increased from pre- to post-decision aid viewing (mean = 2.6 vs. 5.5, difference = 2.8; 95% CI 2.1, 3.6, p < 0.001). Preferences across the overall sample remained similar such that 54% preferred screening at baseline and 50% after viewing; however, 28% of participants changed their preference (to or away from screening) from baseline to after viewing. We assessed screening behavior for 36 participants who had a primary care visit during the 3-month period following enrollment. Eighteen of 36 preferred screening after decision aid viewing. Of these 18, 10 discussed screening, 8 had a test ordered, and 6 completed LDCT. Among the 18 who preferred no screening, 7 discussed screening, 5 had a test ordered, and 4 completed LDCT. Conclusions In primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous. Trial registration This study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016).http://link.springer.com/article/10.1186/s12911-018-0582-1Cancer screeningShared decision makingPrimary careMedicarePulmonary diseases |
| spellingShingle | Daniel S. Reuland Laura Cubillos Alison T. Brenner Russell P. Harris Bailey Minish Michael P. Pignone A pre-post study testing a lung cancer screening decision aid in primary care BMC Medical Informatics and Decision Making Cancer screening Shared decision making Primary care Medicare Pulmonary diseases |
| title | A pre-post study testing a lung cancer screening decision aid in primary care |
| title_full | A pre-post study testing a lung cancer screening decision aid in primary care |
| title_fullStr | A pre-post study testing a lung cancer screening decision aid in primary care |
| title_full_unstemmed | A pre-post study testing a lung cancer screening decision aid in primary care |
| title_short | A pre-post study testing a lung cancer screening decision aid in primary care |
| title_sort | pre post study testing a lung cancer screening decision aid in primary care |
| topic | Cancer screening Shared decision making Primary care Medicare Pulmonary diseases |
| url | http://link.springer.com/article/10.1186/s12911-018-0582-1 |
| work_keys_str_mv | AT danielsreuland aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT lauracubillos aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT alisontbrenner aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT russellpharris aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT baileyminish aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT michaelppignone aprepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT danielsreuland prepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT lauracubillos prepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT alisontbrenner prepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT russellpharris prepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT baileyminish prepoststudytestingalungcancerscreeningdecisionaidinprimarycare AT michaelppignone prepoststudytestingalungcancerscreeningdecisionaidinprimarycare |