JMIR Publications

ABSTRACT

Background:

Patient-provider discussions and shared decision-making (SDM) are essential for tailoring lung cancer screening (LCS) decisions to individual patients. However, implementation of SDM in primary care settings is challenging. Innovative approaches are needed to reach patients eligible for LCS and help them prepare for LCS discussions in primary care settings and to increase the uptake of LCS.

Objective:

We piloted pre-visit preparation comparing two strategies: a paper decision aid (DA) (DA group), and an enhanced comparator strategy consisting of the paper DA plus an automated text message program (DA+TM group) designed to promote patient-provider LCS discussions. We explored feasibility and gathered preliminary data on its potential effects on LCS discussions, decision-making, and LCS uptake in primary care settings.

Methods:

In a sequential quasi-experimental pilot, we recruited patients who were eligible for LCS in a single academic healthcare system. Prior to an upcoming visit, participants in both groups received a paper-based DA by mail. In the DA+TM group, participants also received a series of automated text messages to help them prepare for their LCS discussions. We monitored participant recruitment and retention, and patient engagement in DA and text messages. In exploratory analyses, we assessed patient-provider discussion of LCS, SDM, patient knowledge, decision conflict at baseline and in follow-up telephone surveys, and LCS completion measured by electronic health records.

Results:

We enrolled 49 participants (DA group = 19, DA+TM group = 30). Participants were predominantly White, with a median age of 61.0 (IQR, 57.0-65.0), and 58.3% were female. Engagement in both groups was high. LCS knowledge significantly improved in the DA+TM group (4.5 baseline vs. 6.0 follow-up; P=.003), versus no change in the DA group (5.0 baseline vs. 5.0 follow-up, P=.23). Median LCS knowledge change from baseline to follow-up was 0.5 (IQR -1.0-2.5) in the DA group, and 1.5 (IQR 0-3.0) in the DA+TM group (P=.24). Decision conflict in both groups significantly decreased (DA group: 37.5 baseline vs. 0 follow-up, P<.001; DA+TM group: 50.0 baseline vs. 20.0 follow-up, P=.003). The median SDM process score (a measure of SDM) was 3.0 in the DA group and 2.0 in the DA+TM group (P=.11). The LCS completion rates were 5.3% in the DA group and 31.0% in the DA+TM group at 3 months (P=.07), and 26.3% in the DA group, and 34.5% in the DA+TM group at 6 months (P=.75).

Conclusions:

We showed that pre-visit preparation was feasible in primary care settings. The enhanced strategy utilizing text messaging not only reduced decisional conflict but also improved LCS knowledge. and reduced decisional conflict. An enhanced, text message-based strategy has the potential to reach and engage broader LCS-eligible populations and prepare patients for LCS discussions with their primary care providers, which may ultimately improve informed decision-making and LCS uptake. Clinical Trial: NA