Pilot Study of an Encounter Decision Aid for Lung Cancer Screening

Authors

Mayuko Ito Fukunaga
Akshu Balwan
Jaclyn A. Janis, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Suite 200, Portland, ME, 04074, USA.
Caitlin Gutheil, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Suite 200, Portland, ME, 04074, USA.
Jason Yahwak
Paul K. Han, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Suite 200, Portland, ME, 04074, USA.

Document Type

Article

Publication Date

8-2022

Institution/Department

Oncology; Critical Care Medicine; Pulmonology

Journal Title

Journal of cancer education : the official journal of the American Association for Cancer Education

MeSH Headings

Aged; Decision Making; Decision Support Techniques; Early Detection of Cancer; Female; Humans; Lung Neoplasms (diagnosis, prevention & control); Male; Medicare; Patient Participation; Pilot Projects; United States

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.

First Page

1161

Last Page

1165

Recommended Citation

Ito Fukunaga M, Balwan A, Janis JA, Gutheil C, Yahwak J, Han PKJ. Pilot Study of an Encounter Decision Aid for Lung Cancer Screening. J Cancer Educ. 2022;37(4):1161-1165. doi:10.1007/s13187-020-01933-9