In the first comparative clinical trial of lung cancer screening decision aid vs standard educational information, researchers from The University of Texas MD Anderson Cancer Center showed that a decision aid delivered through tobacco quitlines effectively reaches a screening-eligible population and results in informed decisions about lung cancer screening. These findings were published by Volk et al in JAMA Network Open.

Lung Cancer Screening

Screening for lung cancer with low-dose computed tomography (CT) scans is the only secondary preventive service shown to decrease mortality from lung cancer; the primary action to prevent lung cancer is to avoid or quit using tobacco products. While lung cancer screening can save lives, it also carries potential harms.

For this reason, the Centers for Medicare & Medicaid Services covers lung cancer screening as a preventive service as long as certain requirements are met, including use of a decision aid during a shared decision-making visit between the patient and physician or qualified practitioner. The U.S. Preventive Services Task Force recommends the annual screening for adults aged 55 to 80 who have a 30 pack-year smoking history.

Study Methodology

In the study, the research team worked with 13 tobacco quitlines—telephone-based tobacco cessation services—to identify callers eligible for screening. The 516 quitline clients who enrolled in the study were randomly assigned to receive a decision aid video called “Lung Cancer Screening: Is It Right for Me?” or a standard lung cancer screening brochure for the control group.

The decision aid video explained eligibility for screening; lung cancer epidemiology and risk factors; and potential harms from screening, including false-positive results, radiation exposure, and risks of invasive diagnostic procedures. The decision aid encouraged patients to consider their values while weighing the benefits and harms of screening. The video also showed a patient receiving a CT scan.

Primary outcomes for the study were preparation for decision-making and decisional conflict. Secondary outcomes included knowledge of lung cancer screening, intentions to be screened, and completion of screening within 6 months after receiving the decision aid or brochure.

Results

At the 1-week follow up, 67.4% of participants who received the decision aid reported they were well-prepared to make a screening decision, compared to 48.2% of participants who received the standard educational material. Among those who received the decision aid, 50% felt informed about their decision choice and 68% reported being clear about their values related to the harms and benefits of screening, compared to 28.3% and 47.4%, respectively, in the control group.

By the 6-month follow up, approximately 30% of participants in both groups had scheduled a lung cancer screening; the difference in screening rates between groups was not statistically significant. Nationally, about 6% of people at risk for lung cancer due to smoking undergo screening, according to the National Institutes of Health.

Based on the study results, funding was received to begin implementing the model nationally by training quitline staff to identify callers who are eligible for screening and provide them with the decision aid.

“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 MD Anderson. “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.”

Robert Volk, PhD

“We’ve demonstrated that this is a very effective way to identify people at risk for lung cancer,” he continued. “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.”

Limitations of the study included screening behaviors based on self-report. Quitline callers had to express interest in lung cancer screening when asked by quitline staff in order to participate in the study.

Disclosure: The study was supported by the Patient-Centered Outcomes Research Institute, the National Institutes of Health, and the Duncan Family Institute for Cancer Prevention and Risk Assessment. For full disclosures of the study authors, visit jamanetwork.com.