Tools to Promote Shared Decision-Making in Lung Cancer Screening Using Low-Dose CT Scanning: A Systematic Review

Mayuko Ito Fukunaga, Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Worchester, MA; Division of Health Informatics and Implementation Science, Department of Population Quantitative Health Service, Worchester, MA; Meyers Primary Care Institute, Worcester, MA. Electronic address: mayuko.itofukunaga@umassmed.edu.
Kyle Halligan, Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Worchester, MA.
Jennifer Kodela, Department of Medicine, Worchester, MA.
Shaun Toomey, Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Worchester, MA.
Vanessa Fiorini Furtado, Division of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA.
Roger Luckmann, Department of Family Medicine and Community Health, Worchester, MA; Meyers Primary Care Institute, Worcester, MA.
Paul K. Han, Center for Outcomes Research & Evaluation, Maine Medical Center Research Institute, Portland, ME.
Kathleen M. Mazor, Department of Medicine, Worchester, MA; Meyers Primary Care Institute, Worcester, MA.
Sonal Singh, Department of Family Medicine and Community Health, Worchester, MA; Meyers Primary Care Institute, Worcester, MA.

Abstract

BACKGROUND: Decisions about lung cancer screening are inherently complex and create a need for methods to convey the risks and benefits of screening to patients. RESEARCH QUESTION: What kind of decision aids or tools are available to support shared decision-making for lung cancer screening? What is the current evidence for the effectiveness, acceptability, and feasibility of those tools? STUDY DESIGN AND METHODS: We conducted a systematic review of studies and searched PubMed, MEDLINE, EMBASE, Cochrane Clinical Trials Register, and ClinicalTrials.gov from inception to December 2019 for studies that evaluated the effectiveness and acceptability of tools to promote shared decision-making for patients who are considering lung cancer screening. RESULTS: After screening 2,427 records, we included one randomized control trial, two observational studies, 11 before/after studies of a decision aid or an educational tool. Fifteen distinct tools in various formats were evaluated in 14 studies. Most studies were of fair quality. Studies reported improvement in patients' knowledge of lung cancer screening (n = 9 studies), but improvements in specific areas of knowledge were inconsistent. Decisional conflict was low or reduced after the administration of the tools (n = 7 studies). The acceptability of tools was rated as "high" by patients (n = 7 studies) and physicians (n = 1 study). Low dose CT scan completion rates varied among studies (n = 6 studies). INTERPRETATION: Evidence from 14 studies suggests that some elements of existing tools for lung cancer screening may help to prepare patients for decision-making by improving knowledge and reducing decisional conflict. Such tools generally are acceptable to patients and providers. Further studies that use consistent measures and reporting methods and assess relevant decisional and clinical outcomes are needed to determine the comparative effectiveness and feasibility of implementation of these tools. CLINICAL TRIAL REGISTRATION: PROSPERO 2018 CRD4201874814.