Patient video improves informed decision-making for lung cancer screening
medwireNews: Use of a patient decision aid video (PDA) improves informed decision-making about lung cancer screening among people accessing smoking cessation services in the USA, study findings indicate.
Robert Volk (The University of Texas MD Anderson Cancer Center, Houston, USA) and colleagues say the improvements they observed “were consistent with recommendations of professional societies regarding smokers making informed decisions about lung cancer screening.”
The randomized controlled trial included 516 individuals aged 55–77 years with a 30-plus pack–year smoking history who contacted one of 13 state-wide tobacco quit lines in the USA during 2015 and 2016.
Of these, 259 participants were randomly assigned to receive a 9.5-minute PDA called “Lung Cancer Screening: Is It Right for Me?” while the remaining 257 were given standard 2-page educational material from a lung cancer advocacy group that included questions patients can ask their physician about lung cancer screening.
Volk and co-authors report in JAMA Network Open that, at 1 week after the intervention, participants given the PDA were a significant 2.31-times more likely to be well prepared to make a screening decision than those using the educational material, with 67.4% and 48.2%, respectively, achieving a score of at least 75 out of 100 on the 10-item Preparation for Decision Making Scale.
The PDA was also associated with a significant 2.56-fold increased likelihood that the participants felt informed about their screening choice, with 50.0% versus 28.3% scoring less than 25 out of 100 – a score associated with low decisional conflict – on the Informed Subscale of the Decisional Conflict Scale.
Similarly, participants who watched the PDA were a significant 2.37 times more likely to report being clear about their values related to the harms and benefits of screening than those who did not, according to the Values Clarity subscale of the Decisional Conflict Scale. On this subscale 68.0% and 47.4% reported low decisional conflict, respectively.
In addition, the investigators found that participants who used the PDA were more knowledgeable about the risks and benefits of lung cancer screening than those who did not, but there was no significant difference between the two groups in their intentions to be screened within 1 year (70.8 vs 65.1%) or in the rate of screening among participants who had scheduled a computed tomography scan within 6 months (85.1 vs 80.0%).
This suggests that “participants who received [educational material] were making decisions about lung cancer screening while feeling less prepared, being less clear about their values related to the harms and benefits, and having poorer knowledge of the harms and benefits than participants who received the PDA,” Volk et al remark.
The investigators conclude that their study indicates “that decision aids about lung cancer screening can reach large numbers of smokers who are eligible for screening through tobacco quit lines, can inform them about lung cancer screening, and can promote high-quality screening decisions.”
However, they stress: “The PDA was meant to support but not replace a conversation with a health care clinician because there is a crucial need to improve the quality of these conversations.”
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