Decision-Aid Helped Smokers Weigh CT Lung Cancer Screening

A brief, video-based patient decision aid may help former/current smokers make more-informed decisions about undergoing computed tomography screening for lung cancer, a new study has found. Use of the decision aid resulted in large gains in knowledge about lung cancer and screening.

“With the release of the main findings from the National Lung Screening Trial, direct-to-consumer campaigns were launched encouraging heavy smokers to consider CT scans,” said Robert J. Volk, PhD, professor and deputy director for education at The University of Texas M.D. Anderson Cancer Center. Volk presented the study at the 2013 American Society for Clinical Oncology (ASCO) Annual Meeting.

Initial results of the National Lung Screening Trial were published in 2011 and indicated that screening with low-dose CT reduced mortality from lung cancer. Updated results of the trial were recently released and confirmed that screening with low-dose CT had a sensitivity of 93.8 percent and a specificity of 73.4 percent compared with chest X-ray, which had a sensitivity of 73.5 percent and a specificity of 91.3 percent.

However, undergoing screening with CT is not without its risks, including exposure to radiation.

“Several professional organizations, including ASCO, issued recommendations that people eligible for screening be counseled about the harms and potential benefits of screening with low-dose CT,” Volk said in an interview, “In other words, these groups endorsed an informed decision-making process for screening.”

Volk and colleagues conducted a study of a brief, video-based patient decision aid. The aid was less than six minutes, narrated and included visual depiction of risks and harms and clarification of the implicit values of screening. The study included 52 participants from the M.D. Anderson Cancer Center Tobacco Treatment Program who were current or former heavy smokers aged 45 years to 65 years.

Participants took a pre-test, watched the decisions aid, and then completed a post-test. Participants’ ability to correctly answer several questions about lung cancer screening increased significantly after viewing the decision aid (see table).

Selected Knowledge Questions Answered Correctly Before and After Viewing of the Patient Lung Cancer Screening Decision Aid

Is radiation exposure one of the harms of screening?

“We were surprised that patients’ knowledge of lung cancer screening was so low before viewing the aid, highlighting the important informational function of the tool,” Volk said.

More than 94 percent of participants watched the entire video, rated the content favorably, would recommend the aid to others, and wanted similar video-based aids for other decisions.

After watching the decision aid, 94.1 percent of participants said that they were clear about which benefits mattered most, and 86.5 percent were clear about which harms mattered most. Almost 80 percent of patients said that the aid generated a greater interest in being screened for lung cancer.

“Lung cancer screening with low-dose CT joins a growing list of cancer screening services for which guidelines strongly endorse patients making informed decisions in consultation their health care providers,” Volk said. “As insurers begin to cover lung cancer screening for heavy smokers, patient demand will likely increase as will the need for balanced, high-quality information about the harms and benefits of low-dose CT screening to ensure that patients are making informed decisions.”