Abstract
The Centers for Medicare and Medicaid Services has mandated in-person shared decision-making (SDM) counseling with the use of one or more decision aids (DAs) prior to lung cancer screening. We developed a single-page, paper-based, encounter DA (EDA) to be used within a clinician-patient encounter for lung cancer screening and conducted a pre-post pilot intervention study to evaluate its feasibility and effects on patient decisional conflict. Patients referred to a pulmonary practice-based lung cancer screening program were surveyed before and after an SDM visit with a pulmonologist, who used the EDA to counsel the patient. Patient knowledge of the mortality benefit from screening and the frequency of abnormal screening test results was evaluated after the visit, while decisional conflict was measured before and after the visit using the Decisional Conflict Scale (DCS). Twenty-three patients participated (mean age = 65.8 years; 43% female; mean smoking history = 57.8 pack-years; 48% currently smoking). Following the visit, 28% of participants correctly understood the mortality benefit of lung cancer screening, while 82% understood the frequency of abnormal screening tests. The mean total DCS score decreased from 35.0 to 0.2 after the visit (p < 0.001). These data suggest that a single-page, paper-based EDA is feasible and potentially effective in reducing decision conflict when used within a SDM visit, although more research is needed to establish the independent effects of the EDA, and future efforts to promote SDM may need to devote greater attention to improving patient understanding of the mortality benefit of screening.
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Acknowledgments
We thank Michael Gould, MD, MS; Jamie Studts, Ph.D; and Margaret Byrne, Ph.D for providing expertise on development of this decision aid.
Funding
This research was funded by an Outcomes Research Grant from the Maine Cancer Foundation. Additional support was provided by the Maine Lung Cancer Coalition, an initiative jointly supported by the Bristol Myers Squibb Foundation, Maine Cancer Foundation, and the Maine Economic Improvement Fund.
A part of MIF’s work was supported by the National Heart, Lung, and Blood Institute through Grant 1K12HK138049-01.
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Ito Fukunaga, M., Balwan, A., Janis, J.A. et al. Pilot Study of an Encounter Decision Aid for Lung Cancer Screening. J Canc Educ 37, 1161–1165 (2022). https://doi.org/10.1007/s13187-020-01933-9
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DOI: https://doi.org/10.1007/s13187-020-01933-9