Researchers Describe Possibilities for Improving Lung Cancer Screening in Smokers

A decision aid delivered through tobacco quitlines may improve informed decision making about lung cancer screening, according to study findings published in JAMA Network Open.

In previous research, low-dose computed tomography (CT) scans for lung cancer screenings are the only secondary preventive service demonstrated to decrease mortality from lung cancer, with the primary action of preventing lung cancer being to avoid tobacco products.

Researchers conducted a study involving 13 tobacco quitlines to identify callers for screening. In total, 516 quitline clients were enrolled, randomized to receive either a decision aid video called “Lung Cancer Screening: Is It Right for Me?” or a standard lung cancer screening brochure (control group).

The decision aid video outlined eligibility for screening, lung cancer epidemiology and risk factors, and potential harms from screening. In addition, it shows a video of a patient receiving a CT scan.

The results revealed that after 1 week, 67.4% of participants who received the decision aid had reported that they were well prepared to make a screening decision. Conversely, 48.2% of participants who received the standard educational material thought they could make such a decision.

"The quitline clients who received the decision aid were more assured about what was important to them in making the choice about screening and felt better informed," said lead study author Robert Volk, PhD, professor of Health Services Research at the University of Texas MD Anderson Cancer Center, in a statement. "Their knowledge of the harms and benefits of screening was much greater than people who received standard educational information. The clients in the control group were making screening choices while being less prepared and aware of the trade-offs between benefit and harms. We want to head off the uninformed choice and help patients make good, informed decisions about screening."

Additionally, 50% of those who received the decision aid felt informed about their decision choice and 68% reported being clear about their values related to the harmed and benefits of screening, compared to 28.3% and 47.4% of the control group, respectively, according to the results.

"We've demonstrated that this is a very effective way to identify people at risk for lung cancer," said Volk. "There's potential to reach thousands of people who are eligible for screening and already addressing their risk for lung cancer by seeking cessation services."

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 [published online January 31, 2020]. JAMA Netw Open. doi: 10.1001/jamanetworkopen.2019.20362.