WHAT ATTRIBUTES OF A LUNG CANCER SCREENING TEST AFFECT INTEREST IN BEING SCREENED?

Purpose: To use conjoint valuation analysis to determine what attributes of a lung cancer screening test affect interest in being screened and whether this varies by individual characteristics among individuals at higher risk of lung cancer.

Method: Participants of the nationally representative Knowledge Networks panel who were at increased risk of lung cancer due to cigarette smoking were surveyed. The survey included a conjoint valuation exercise (CVE), which assessed preferences for lung cancer screening by having participants indicate likelihood of screening on a scale of 1-9 in 20 hypothetical scenarios. CVE scenarios had 5 attributes: out of pocket costs, mortality reduction from screening, healthcare provider recommendation, false positive rate, and convenience of screening. We calculated average and individual attribute relative importance scores and part-worth utilities, and used Hierarchical Bayesian regression analysis to determine if relative importance was associated with individual characteristics.

Result: The sample included 210 participants with an average age of 60.7±8.5, pack year smoking history of 40.0±20.1, 52% female, 25.1% African American, and 28.5% Hispanic. Mean±SD relative importance scores for attributes were:  cost – 27.3±17.7; provider recommendation – 24.8±13.4; mortality reduction – 17.2±8.9; false positive rate – 15.8±10.6; and convenience of access – 14.8±7.3. All of the levels’ utilities moved in the expected directions. 41% of all participants had cost as the highest importance score; only, 12% and 11% had mortality reduction and false positive rate as highest importance. Only 8% individuals had the lowest individual score for provider recommendation, 15% with lowest score for cost, and 29% had the lowest individual score for false positive rate. A few associations were robust in univariate and multivariate analyses. Older age was associated with lower importance of out of pocket cost and a greater importance of physician recommendation; being female was associated with lower importance of cost.

Conclusion: Cost of the screening test and provider recommendations for screening were the most important attributes in decisions to be screened, whereas mortality reduction and false positive rate were viewed as relatively less important. Thus, these data suggest individuals may not be sufficiently informed regarding notable risks and benefits of screening.  With interest in lung cancer screening likely to rise following the NLST results and changing guidelines, developing tools to promote informed decision-making concerning lung cancer screening is of the utmost importance.