Purpose: This study explored whether receiving information about lung cancer screening (LCS) and completing a values clarification exercise affects decisional conflict regarding LCS among individuals with a significant history of cigarette smoking.
Method: Participants were drawn from the Knowledge Networks panel. Of 223 eligible respondents, 210 (94%) consented and participated. Participants had a high risk of lung cancer (40±20 pack years) and were an average age of 61 (±8) years. The sample included 109 (52%) women, 51 (24%) African Americans, and 59 (28%) Hispanic Americans. Prior to receiving a brief description of LCS and completing the conjoint exercise, participations were administered the 10-item low literacy version of the Decisional Conflict Scale (DCS-LL). The brief LCS description provided information regarding options and potential risks/benefits. The conjoint exercise, which was used for values clarification, included 20 scenarios depicting 5 attributes and 17 levels. Participants were asked to respond to each scenario regarding how likely it was that s/he would be screened using response options that ranged from 1 (definitely would not get screened) to 9 (definitely would get screened). Additionally, participants completed 20 survey items that asked them to rate the importance of LCS attributes on a screening decision using a 1-10 scale. Participants then completed the DCS-LL again.
Result: At baseline, participants reported a high level of decisional conflict regarding LCS (M=46.96±27.03, Range: 0 to 100). However, decisional conflict was significantly reduced following the brief LCS introduction and the conjoint exercise (M=17.55±21.40: Range 0 to 100), t(192)=15.54, p<.001, d=1.14. Examination of change in DCS subscales also demonstrated significant differences across all four subscales: uncertainty t(192)=10.06, p<.001, d=.73, informed t(192)=15.99, p<.001, d=1.17, values clarity t(192)=11.78, p<.001, d=.86, and support t(192)=9.26, p<.001, d=.68.
Conclusion: These data suggest that individuals at high risk for lung cancer were generally unprepared to make informed decisions about LCS, but brief educational material combined with a values clarification exercise dramatically reduced decisional conflict. These data support the value of developing a patient decision aid to promote informed decision making about LCS. Future work is needed to design and evaluate a patient decision aid that integrates a risk assessment tool and promotes shared decision making with health care providers.