PS 1-40 EFFECT OF A LUNG CANCER SCREENING DECISION AID ON KNOWLEDGE OF SCREENING HARMS AND SCREENING PREFERENCE IN PRIMARY CARE PATIENTS

Sunday, October 23, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 1-40

Daniel S. Reuland, MD, MPH1, Alison Brenner, PhD2, Laura Cubillos, MPH3, Russel Harris, MD MPH4, Bailey Minish3 and Michael Pignone, MD, MPH1, (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)University of North Carolina at Chapel Hill, Chapel Hill, NC, NC, (4)Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
Purpose:

Little is known about how decision aids may affect patients’ understanding of the potential harms associated with lung cancer screening. We aimed to assess the effect of a multi-media lung cancer screening decision aid on primary care patients’ knowledge of potential screening harms and their preferences for initiating lung cancer screening.  

Method:

We conducted a single-site, pre-post pilot study in an academic primary care practice serving a diverse population. Participants met US Preventive Services Task Force eligibility criteria for lung cancer screening (55-80 years old, 30+ pack-year smoking history, and currently smoke or quit <16 years ago). Participants viewed a 6-minute, multi-media decision aid that reviewed the benefits and harms of lung cancer screening and encouraged viewers to consider their own values and preferences. Main outcome measures were pre-post changes in knowledge about principal harms associated with screening (false positives and overdiagnosis) on an 8-point scale, and preference (for or against) initiating screening on a 5-point Likert item, dichotomized for analysis. Secondarily, we explored the association between knowledge of harms and screening preference using simple logistic regression. 

Result:

Participants characteristics (n=41): mean age 64 years; 51% female; 56% white, 32% black, 10% American Indian; 32% had limited health literacy (54% HS or less); 49% current smokers; mean 52 pack-years smoked. The mean knowledge score increased from 2.5 to 4.6 out of 8; difference 2.1 (95%CI 1.4, 2.8)   The proportion of participants indicating a preference to initiate lung cancer screening decreased from 66% to 54%; absolute difference 12%, (95%CI -0.09%, 33%). Greater knowledge was marginally associated with lower screening intent OR 0.68 (95%CI 0.46, 1.00).

Conclusion: In a diverse primary care population, viewing a decision aid was associated with greater knowledge about the potential harms of lung cancer screening as well as modest reductions in preference for screening.  Using a lung cancer screening decision aid may improve patients’ awareness of potential screening harms.

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See more of: 38th Annual North American Meeting of the Society for Medical Decision Making