What is the effect of a decision aid on knowledge, values and preferences for lung cancer screening? An online pre-post study.
Ontology highlight
ABSTRACT: Objective
To examine if a decision aid improves knowledge of lung cancer screening benefits and harms and which benefits and harms are most valued.Design
Pre-post study.Setting
Online.Participants
219 current or former (quit within the previous 15 years) smokers ages 55-80 with at least 30 pack-years of smoking.Intervention
Lung cancer screening video decision aid.Main measures
Screening knowledge tested by 10 pre-post questions and value of benefits and harms (reducing chance of death from lung cancer, risk of being diagnosed, false positives, biopsies, complications of biopsies and out-of-pocket costs) assessed through rating (1-5 scale) and ranking (top three ranked).Results
Mean age was 64.7±6.1, 42.5% were male, 75.4% white, 48.4% married, 28.9% with less than a college degree and 67.6% with income
SUBMITTER: Clark SD
PROVIDER: S-EPMC8273450 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
What is the effect of a decision aid on knowledge, values and preferences for lung cancer screening? An online pre-post study.
Clark Stephen D SD Reuland Daniel S DS Brenner Alison T AT Pignone Michael P MP
BMJ open 20210709 7
<h4>Objective</h4>To examine if a decision aid improves knowledge of lung cancer screening benefits and harms and which benefits and harms are most valued.<h4>Design</h4>Pre-post study.<h4>Setting</h4>Online.<h4>Participants</h4>219 current or former (quit within the previous 15 years) smokers ages 55-80 with at least 30 pack-years of smoking.<h4>Intervention</h4>Lung cancer screening video decision aid.<h4>Main measures</h4>Screening knowledge tested by 10 pre-post questions and value of benefi ...[more]
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Project description:BackgroundThe 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.MethodsWe 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.ResultsAmong 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.ConclusionsIn primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous.Trial registrationThis study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016).
| S-EPMC5765651 | biostudies-literature
Project description: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.
| S-EPMC8260603 | biostudies-literature
Project description:IntroductionInformed decision making has been highlighted as an important aspect of lung cancer screening programs. This study seeks to assess the efficacy of a web-based patient decision aid for lung cancer screening, www.shouldiscreen.com.MethodsA before-and-after study (August through December 2014) was conducted where participants navigated a web-based decision aid that provided information about low-dose computed tomography lung cancer screening. Using an established prediction model, the decision aid computed baseline lung cancer risk and an individual's chances of benefiting from, and risk of being harmed by, screening. Outcome measures included knowledge of lung cancer risk factors and lung cancer screening, decisional conflict, concordance, and acceptability of the decision aid. Data were collected from 60 participants who were current or former smokers, had no history of lung cancer, and had not received a chest computed tomographic scan in the previous year. Analysis took place in 2015.ResultsKnowledge increased after seeing the decision aid compared with before (p<0.001), whereas the score on the Decisional Conflict Scale decreased (p<0.001). Concordance between a participant's preference to screen and the U.S. Preventive Services Task Force recommendation improved after seeing the decision aid (p<0.001). Risk perceptions among the screen-ineligible group changed (n=49), contrary to those who were eligible (n=11). Ninety-seven percent of the participants reported that the decision aid was likely useful for lung cancer screening decision making.ConclusionsThe web-based decision aid should be a helpful resource for individuals considering lung cancer screening, as well as for practitioners and health systems with lung cancer screening programs.
| S-EPMC5544524 | biostudies-literature
Project description:ImportanceMedical aid in dying (MAID) is legal in jurisdictions covering more than one-fifth of the US population and has been used by a largely White, educated population. The extent to which knowledge of MAID and preferences for personal use align with patterns of use is unknown.ObjectiveTo evaluate knowledge among US adults of the legal status of MAID as well as interest in using MAID.Design, setting, and participantsThis cross-sectional, self-report online survey study used a national Prime Panels-based sample of US adults recruited between July 16 and August 10, 2024. A total of 3227 respondents aged 18 years or older from all US states and Washington, DC, were included. Individuals from states with legal MAID, aged 60 years or older, and members of racial and ethnic minority groups were oversampled.Main outcomes and measuresKnowledge of the legality of MAID in the US and in respondents' state of residence as well as potential interest in future use of MAID. Descriptive statistics and χ2 tests were used to examine associations by demographic characteristics and place of residence.ResultsOf 3227 respondents (mean [SD] age, 55.7 [17.4] years; 1839 women [57.0%]), 1654 (51.3%) did not know if MAID was legal the US, and 1638 (50.8%) did not know if MAID was legal in their state. Respondents in states where MAID is legal were more likely to know that MAID is legal in the US compared with those in states where MAID is not legal (728 of 2164 [33.6%] vs 216 of 1063 [20.3%]; P < .001). Across all respondents, 1420 (44.0%), including 96 of 222 Asian respondents (43.2%), 206 of 605 Black respondents (34.0%), and 129 of 308 Hispanic respondents (41.9%), reported they would definitely or probably consider MAID if they received a diagnosis of a terminal illness.Conclusions and relevanceIn this online survey study of US adults, substantial interest in using MAID as well as significant knowledge gaps regarding the legality of MAID were reported. These findings highlight the need for public education, policy initiatives, and patient-clinician discussions to ensure equitable access to patient-centered end-of-life options and informed decision-making.
| S-EPMC11851238 | biostudies-literature
Project description:BackgroundWeb-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool).ObjectiveThis study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center.MethodsUsability testing of the LCSDecTool was conducted in a prototype version (phase 1) and a high-fidelity version (phase 2). A total of 18 veterans and 8 clinicians participated in phase 1, and 43 veterans participated in phase 2. Quantitative outcomes from the users included the System Usability Scale (SUS) and the End User Computing Satisfaction (EUCS) in phase 1 and the SUS, EUCS, and Patient Engagement scale in phase 2. Qualitative data were obtained from observations of user sessions and brief interviews. The results of phase 1 informed the modifications of the prototype for the high-fidelity version. Phase 2 usability testing took place in the context of a pilot hybrid type 1 effectiveness-implementation trial.ResultsIn the phase 1 prototype usability testing, the mean SUS score (potential range: 0-100) was 81.90 (SD 9.80), corresponding to an excellent level of usability. The mean EUCS score (potential range: 1-5) was 4.30 (SD 0.71). In the phase 2 high-fidelity usability testing, the mean SUS score was 65.76 (SD 15.23), corresponding to a good level of usability. The mean EUCS score was 3.91 (SD 0.95); and the mean Patient Engagement scale score (potential range 1 [low] to 5 [high]) was 4.62 (SD 0.67). The median time to completion in minutes was 13 (IQR 10-16). A thematic analysis of user statements documented during phase 2 high-fidelity usability testing identified the following themes: a low baseline level of awareness and knowledge about LCS increased after use of the LCSDecTool; users sought more detailed descriptions about the LCS process; the LCSDecTool was generally easy to use, but specific navigation challenges remained; some users noted difficulty understanding medical terms used in the LCSDecTool; and use of the tool evoked veterans' struggles with prior attempts at smoking cessation.ConclusionsOur findings support the development and use of this eHealth technology in the primary care clinical setting as a way to engage veterans, inform them about a new cancer control screening test, and prepare them to participate in an SDM discussion with their provider.
| S-EPMC9034418 | biostudies-literature
Project description:BackgroundPeople with HIV are both at elevated risk of lung cancer and at high risk of multimorbidity, which makes shared decision-making (SDM) for lung cancer screening (LCS) in people with HIV complex. Currently no known tools have been adapted for SDM in people with HIV.Research questionCan an SDM decision aid be adapted to include HIV-specific measures with input from both people with HIV and their providers?Study design and methodsThis study used qualitative methods including focus groups of people with HIV and interviews with HIV care providers to adapt and iterate an SDM tool for people with HIV. Eligible participants were those with HIV enrolled in an HIV primary care clinic who met age and smoking eligibility criteria for LCS and HIV care providers at the clinic. Both the focus groups and interviews included semistructured discussions of SDM and decision aid elements for people with HIV. We used a framework-guided thematic analysis, mapping themes onto the Health Equity Implementation framework.ResultsForty-three people with HIV participated in eight focus groups; 10 providers were interviewed. Key themes from patients included broad interest in adapting LCS SDM specifically for people with HIV, a preference for clear LCS recommendations, and the need for positive framing emphasizing survival. Providers were enthusiastic about personalized LCS risk assessments and point-of-care tools. Both patients and providers gave mixed views on the usefulness of HIV-specific risk measures in patient-facing tools. Themes were used to adapt a personalized and flexible SDM tool for LCS in people with HIV.InterpretationPeople with HIV and providers were enthusiastic about specific tools for SDM that are personalized and tailored for people with HIV, that make recommendations, and that inform LCS decision-making. Divergent views on presenting patient-facing quantitative risk assessments suggests that these elements could be optional but available for review. This tool may have usefulness in complex decision-making for LCS in this population and currently is being evaluated in a pilot prospective trial.
| S-EPMC11465906 | biostudies-literature
Project description:Background The risk of developing type 2 diabetes mellitus (T2DM) is up to 50% among women with gestational diabetes mellitus (GDM). GDM also increases risks for pre-term birth, macrosomia, fetal hypoglycemia, and C-section delivery. Education for expectant mothers with GDM about nutrition, exercise, and the risks of developing T2DM after delivery enhances the probability of postpartum diabetes screening. However, the availability of diabetes education is limited. To bridge this gap, our team developed four training modules on GDM tailored for nurses and community health workers. This pilot study assesses changes in knowledge, self-efficacy for providing diabetes education, attitudes, and intentions to recommend diabetes prevention before and after training completion. Methods These interactive online modules, each lasting 45-60 minutes and featuring engaging case studies and integrated knowledge assessment questions, were disseminated through various professional organizations to clinical staff providing care for women with GDM. Optional pre- and post-training surveys were conducted to gauge the effectiveness of the modules. Collected data did not follow a normal distribution pattern. We provided an overview of the baseline characteristics of the population, self-efficacy, attitudes, intentions, and GDM knowledge by calculating the median scores and interquartile ranges. We assessed the changes in scores on self-efficacy, attitudes, intentions, and GDM knowledge before and after training using non-parametric Wilcoxon matched-pair signed rank tests. Results Eighty-two individuals completed baseline evaluation and 20 individuals accessed all modules and completed post-training assessments. Among those completing the training, improvement was noted in GDM knowledge [56.5% (16.0) v. 78.3% (22.0), p < 0.001], Self-efficacy for providing diabetes education [6.60 (2.73) v. 9.33 (0.87), p < 0.001], attitudes toward the value of tight control [4.07 (0.79) v. 4.43 (0.86), p = 0.003], and intentions to recommend diabetes prevention measures [4.81 (0.63) v. 5.00 (0.00), p = 0.009)]. Conclusions Completion of our interactive online modules improved knowledge, intention to recommend diabetes prevention methods, self-efficacy to provide diabetes education, and attitudes toward the value of tight control among individuals caring for women with GDM. Enhanced accessibility to such curricula is crucial to improve access to diabetes education. Trial registration This study was registered at clinicaltrials.gov, identifier: NCT04474795.
| S-EPMC10312972 | biostudies-literature
Project description:ImportanceDecision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether "personalising" choice within decisions aids leads to better decision quality.ObjectiveTo assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test.DesignRandomized controlled trial.SettingAustralia.Participants1,970 men aged 40-69 years were approached to participate in the trial.Intervention1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes.Outcome measuresTo determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes.Results5% of men in the fixed attribute group scored 'Have a PSA test' as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months.ConclusionsTogether, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886.
| S-EPMC4822955 | biostudies-literature
Project description:ImportanceGuidelines recommend shared decision-making prior to initiating lung cancer screening (LCS). However, evidence is lacking on how to best implement shared decision-making in clinical practice.ObjectiveTo evaluate the impact of an LCS Decision Tool (LCSDecTool) on the quality of decision-making and LCS uptake.Design, setting, and participantsThis randomized clinical trial enrolled participants at Veteran Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut, from March 18, 2019, to September 29, 2021, with follow-up through July 18, 2022. Individuals aged 55 to 80 years with a smoking history of at least 30 pack-years who were current smokers or had quit within the past 15 years were eligible to participate. Individuals with LCS within 15 months were excluded. Of 1047 individuals who were sent a recruitment letter or had referred themselves, 140 were enrolled.InterventionA web-based patient- and clinician-facing LCS decision support tool vs an attention control intervention.Main outcome and measuresThe primary outcome was decisional conflict at 1 month. Secondary outcomes included decisional conflict immediately after intervention and 3 months after intervention, knowledge, decisional regret, and anxiety immediately after intervention and 1 and 3 months after intervention and LCS by 6 months.ResultsOf 140 enrolled participants (median age, 64.0 [IQR, 61.0-69.0] years), 129 (92.1%) were men and 11 (7.9%) were women. Of 137 participants with data available, 75 (53.6%) were African American or Black and 62 (44.3%) were White; 4 participants (2.9%) also reported Hispanic or Latino ethnicity. Mean decisional conflict score at 1 month did not differ between the LCSDecTool and control groups (25.7 [95% CI, 21.4-30.1] vs 29.9 [95% CI, 25.6-34.2], respectively; P = .18). Mean LCS knowledge score was greater in the LCSDecTool group immediately after intervention (7.0 [95% CI, 6.3-7.7] vs 4.9 [95% CI, 4.3-5.5]; P < .001) and remained higher at 1 month (6.3 [95% CI, 5.7-6.8] vs 5.2 [95% CI, 4.5-5.8]; P = .03) and 3 months (6.2 [95% CI, 5.6-6.8] vs 5.1 [95% CI, 4.4-5.8]; P = .01). Uptake of LCS was greater in the LCSDecTool group at 6 months (26 of 69 [37.7%] vs 15 of 71 [21.1%]; P = .04).Conclusions and relevanceIn this randomized clinical trial of an LCSDecTool compared with attention control, no effect on decisional conflict occurred at 1 month. The LCSDecTool used in the primary care setting did not yield a significant difference in decisional conflict. The intervention led to greater knowledge and LCS uptake. These findings can inform future implementation strategies and research in LCS shared decision-making.Trial registrationClinicalTrials.gov Identifier: NCT02899754.
| S-EPMC10469267 | biostudies-literature
Project description:BackgroundDecisions aids (DA) can support patients to make informed decisions about screening tests. This study describes the development and initial evaluation of a lung cancer screening (LCS) DA targeted towards survivors of Hodgkin lymphoma (HL).MethodsA prototype decision aid booklet was developed and subsequently reviewed by a steering group who provided feedback. Revisions were made to produce the DA tested in this study. HL survivors were recruited to an online survey and/or focus groups. Lymphoma practitioners were invited to an interview study. In the online survey, decisional conflict scales and knowledge scales were completed before and after accessing the DA. The focus groups and interviews explored acceptability and comprehensibility and the decisional needs of stakeholders. Focus groups and interviews were audio recorded. The framework method was used to analyse qualitative data.Results38 HL survivors completed the online survey. Following exposure to the DA, knowledge of LCS and risk factors and decisional conflict scores (total score and subscale scores) improved significantly. 11 HL survivors took part in two focus groups (n = 5 and n = 6) and 11 practitioners were interviewed. Focus group and interview results: The language, format and length were considered acceptable. Both groups felt the DA was balanced and presented a choice. Icon arrays were felt to aid comprehension of absolute risk values and for some survivors, they reduced affective risk perceptions. Among survivors, the impact of radiation risk on decision making varied according to gender and screening interval, whilst practitioners did not anticipate it to be a major concern for patients. Both groups expressed that a screening offer could mitigate anxiety about lung cancer risk. As anticipated by practitioners, survivors expressed a desire to seek advice from their clinical team. Practitioners thought the DA would meet their informational needs regarding LCS when supporting survivors.ConclusionsThe DA is considered acceptable by HL survivors and practitioners. The DA reduces decisional conflict and improves knowledge in HL survivors, suggesting that it would support HL survivors to make informed decisions when considering LCS in a future clinical trial.
| S-EPMC8805261 | biostudies-literature