Abstract
Abstract
Background
Lung cancer screening (LCS) is recommended for individuals at high risk due to age and smoking history after a shared decision-making conversation. However, little is known about best strategies for incorporating shared decision-making, especially in a busy primary care setting.
Objective
To develop a novel tool, Lung Cancer Assessment of Risk and Education (LungCARE) to guide LCS decisions among eligible primary care patients.
Design
Pilot cluster randomized controlled trial of LungCARE versus usual care.
Participants
Patients of providers in a university primary care clinic, who met criteria for LCS.
Intervention
Providers were randomized to LungCARE intervention or control. LungCARE participants completed a computer tablet-based video assessment of lung cancer educational needs in the waiting room prior to a primary care visit. Patient and provider both received a summary handout of patient concerns and responses.
Main Measures
All eligible patients completed baseline interviews by telephone. One week after the index visit, participants completed a follow-up telephone survey that assessed patient-physician discussion of LCS, referral to and scheduling of LCS, as well as LCS knowledge and acceptability of LungCARE. Two months after index visit, we reviewed patients’ electronic health records (EHRs) for evidence of a shared decision-making conversation and referral to and receipt of LCS.
Key Results
A total of 66 participants completed baseline and follow-up visits (34: LungCARE; 32: usual care). Mean age was 65.9 (± 6.0). Based on EHR review, compared to usual care, LungCARE participants were more likely to have discussed LCS with their physicians (56% vs 25%; p = 0.04) and to be referred to LCS (44% vs 13%; p < 0.02). Intervention participants were also more likely to complete LCS (32% vs 13%; p < 0.01) and had higher knowledge scores (mean score 6.5 (± 1.7) vs 5.5 (± 1.4; p < 0.01).
Conclusions
LungCARE increased discussion, referral, and completion of LCS and improved LCS knowledge.
Clinical Trial Registration
NCT03862001.
Funder
Tobacco-Related Disease Research Program
National Institute on Aging
Publisher
Springer Science and Business Media LLC
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