PS1-53 USING DELIBERATIVE METHODS TO GUIDE IMPLEMENTATION OF LUNG CANCER SCREENING

Sunday, October 18, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS1-53

Daniel S. Reuland, MD, MPH1, Alison Brenner, PhD2, Laura Cubillos Braswell, MPH2, Maihan Vu, DrPH, MPH3, Louise Henderson, PhD4, Patricia Rivera, MD5, Katherine Birchard, MD6, Michael Pignone, MD, MPH1 and Russel Harris, MD MPH7, (1)University of North Carolina School of Medicine, Chapel Hill, NC, (2)Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, (3)Center for Health Promotion and Disease Prevention. The University of North Carolina at Chapel Hill, Chapel Hill, NC, (4)Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, (5)Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC, (6)Cardiothoracic Imaging Division, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, (7)Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Purpose: Implementing lung cancer screening (LCS) is complex and involves value judgments about benefits and harms in screened populations. We tested a multi-level deliberative process to guide LCS implementation in an academic health system. 

Method: We convened three deliberative group sessions, a Network Panel (institutional subspecialty and primary care experts and leaders), a Practice Panel (primary care practitioners and quality improvement coaches) and a one-day Citizens’ Panel (screening guideline-eligible patients). Sessions included an informational component (summarizing evidence regarding LCS benefits and harms) and a deliberation component (soliciting perspectives about screening implementation). We analyzed session notes and transcripts for themes and points of consensus. The Citizens’ Panel evaluation also included pre-post assessment of LCS knowledge including mortality reduction, false positives, over-detection/over-treatment. 

Result: The Network Panel (n=10) reached consensus on key implementation principles, including having uniform institution-wide protocols for offering LCS, prioritizing population benefit, providing high-quality decision support and smoking cessation interventions, and standardizing lung nodule reporting and management. Practitioners (n=13) endorsed these principles and provided specific suggestions for protocols to identify screening-eligible patients and for a one-page decision aid. Both Network and Practice panelists were willing to limit active and systematic offering of LCS to higher-risk subgroups most likely to benefit. For the Citizens Panel (n=11: 5 women, 5 current/6 former smokers, ages 56-72 years, average 49 pack-years smoked), themes included surprise and concern regarding the small absolute benefit of LCS, the high false positive rate, the possibility of over-detection/over-treatment, and potential anxiety and costs associated with evaluating screen-detected nodules. Participants suggested having trained nurse-educators help patients understand the complex benefits and harms of LCS. Participants agreed with actively offering LCS to groups most likely to benefit; however, they were divided on whether the topic of LCS should be systematically raised with patients who were guideline-eligible but had low chances of benefiting (5 for, 6 against). Pre-post LCS knowledge scores increased by 2.7 (95%CI 1.7, 3.8) points on a 6-point scale. 

Conclusion: Using a multi-level deliberative process to bring informed perspectives to health-system LCS implementation is feasible. Deliberation yielded broad consensus on key implementation principles. Citizens (patients) found the population-level benefit to be smaller and the harms greater than they expected, and they were divided on offering LCS to guideline-eligible patients with low likelihood of benefitting.