JMIR Publications

ABSTRACT

Background:

Introduction: Lung cancer screening is a U. S. Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, lung cancer screening is a complex decision secondary to potential risks (e.g., false positive results, overdiagnosis). Shared decision-making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision-making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed.

Objective:

Objective:

To estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision-making in lung cancer screening decisions.

Methods:

Methods:

A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Thirty one participants were randomized to view LungTalk – a web-based tailored computer program, while 29 viewed generic information about lung cancer screening from the American Cancer Society. Outcomes compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician.

Results:

Results:

Knowledge scores increased signficantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 change in means). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions.

Conclusions:

Discussion: LungTalk goes beyond other decision tools by addressing lung health broadly in the context of performing an LDCT of the chest that has the potential to uncover other conditions of concern beyond lung cancer to more comprehensively educate the individual, and extends the work of the non-tailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention are driving behavior change when an individual is informed and makes the decision to screen, or not for lung cancer.