Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial.

BACKGROUND: Lung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed. OBJECTIVE: The aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions. METHODS: A pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk-a web-based tailored computer program-while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician. RESULTS: Knowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions. CONCLUSIONS: LungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/resprot.8694.

Smoking-Related Social Interactions as Experienced by Persons Who Smoked Long-term.

PURPOSE/AIMS: Smoking-related stigma is manifested in the everyday social interactions of persons who smoke and can result in low self-esteem, diminished self-efficacy, and resistance to smoking cessation. The purpose of this study was to describe smoking-related social interactions as experienced by persons with a history of long-term smoking. DESIGN: This study used a qualitative descriptive approach. METHODS: This study is part of a larger study designed to identify factors that influence lung cancer screening participation. Data were drawn from 39 qualitative interviews with persons from the parent study. All descriptions about smoking-related social interactions found in the narratives were extracted, coded, categorized, and summarized with content analytic techniques. RESULTS: Seven different types of social interactions were identified: (a) being looked down on for smoking, (b) being humiliated for smoking in public, (c) being banished while smoking, (d) being blamed for one's health problems, (e) not "really" being blamed for smoking, (f) being told "just quit," and (g) being worried about hurting others. CONCLUSIONS: Clinical nurse specialists should promote antismoking campaigns that are not stigmatizing, discuss health risks of smoking in a respectful manner, provide evidence-based cessation resources, improve communication with persons who smoke, and address stigma in programs to improve screening for smoking-related illnesses.

Integration Through Connecting in Explanatory Sequential Mixed Method Studies.

The purposes of this methods article are to (a) discuss how integration can occur through a connecting approach in explanatory sequential mixed methods studies, (b) describe a connecting strategy developed for a study testing a conceptual model to predict lung cancer screening, and (c) describe three analytic products developed by subsequent integration procedures enabled by the connecting strategy. Connecting occurs when numeric data from a quantitative strand of a study are used to select a sample to be interviewed for a subsequent qualitative strand. Because researchers often do not fully exploit numeric data for this purpose, we developed a multi-step systematic sampling strategy that produced an interview sample of eight subgroups of five persons (n = 40) whose profiles converged with or diverged from the conceptual model in specified ways. The subgroups facilitated the development of tailored interview guides, in-depth narrative summaries, and exemplar case studies to expand the quantitative findings.

Understanding lung cancer screening behaviour using path analysis.

OBJECTIVE: Understanding lung cancer screening behaviour is crucial to identifying potentially modifiable factors for future intervention. Qualititative work has explored attitudes and beliefs about lung cancer screening from the perspective of the participant, but the theoretically grounded factors that influence screening-eligible individuals to screen are unknown. We tested an explanatory framework for lung cancer screening participation from the individual's perspective. METHODS: Data were collected as part of a sequential explanatory mixed methods study, the quantitative component of which is reported here. A national purposive sample of 515 screening-eligible participants in the United States was recruited using Facebook-targeted advertisement. Participants completed surveys assessing constructs of the Conceptual Model for Lung Cancer Screening Participation. Path analysis was used to assess the relationships between variables. RESULTS: Path analyses revealed that a clinician recommendation to screen, higher self-efficacy scores, and lower mistrust scores were directly associated with screening participation (p < 0.05). However, the link between screening behaviour and self-efficacy appeared to be fully mediated by fatalism, lung cancer fear, lung cancer family history, knowledge of lung cancer risk and screening, income, clinician recommendation, and social influence (p < 0.05). CONCLUSIONS: This study found that medical mistrust, self-efficacy, and clinician recommendation were significant in the decision of whether to screen for lung cancer. These findings offer insight into potentially modifiable targets most appropriate on which to intervene. This understanding is critical to design meaningful clinician- and patient-focused interventions.

Understanding the decision to screen for lung cancer or not: A qualitative analysis.

BACKGROUND: Although new screening programmes with low-dose computed tomography (LDCT) for lung cancer have been implemented throughout the United States, screening uptake remains low and screening-eligible persons' decisions to screen or not remain poorly understood. OBJECTIVE: To describe how current and former long-term smokers explain their decisions regarding participation in lung cancer screening. DESIGN: Phone interviews using a semi-structured interview guide were conducted to ask screening-eligible persons to describe their decisions regarding screening with LDCT. The interviews were transcribed and analysed with conventional content analytic techniques. SETTING AND PARTICIPANTS: A subsample of 40 participants (20 who had screened and 20 who had not) were drawn from the sample of a survey study whose participants were recruited by Facebook targeted advertisements. RESULTS: The sample was divided into the following five groups based on their decisions regarding lung cancer screening participation: Group 1: no intention to be screened, Group 2: no deliberate consideration but somewhat open to being screened, Group 3: deliberate consideration but no definitive decision to be screened, Group 4: intention to be screened and Group 5: had been screened. Reasons for screening participation decisions are described for each group. Across groups, data revealed that screening-eligible persons have a number of misconceptions regarding LDCT, including that a scan is needed only if one is symptomatic or has not had a chest x-ray. A physician recommendation was a key influence on decisions to screen. DISCUSSION AND CONCLUSIONS: Education initiatives aimed at providers and long-term smokers regarding LDCT is needed. Quality patient/provider communication is most likely to improve screening rates.

Development and Usability Testing of a Computer-Tailored Decision Support Tool for Lung Cancer Screening: Study Protocol.

BACKGROUND: Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed. OBJECTIVE: Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions. METHODS: Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening. RESULTS: Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first follow-up survey. We expect to have results by December 31, 2017 and to have data analysis completed by March 1, 2018. CONCLUSIONS: Results from usability testing indicate that the computer-tailored decision support tool is easy to use, is helpful, and provides a satisfactory experience for the user. At the conclusion of phase III (pilot RCT), we will have preliminary effect sizes to inform a future fully powered RCT on changes in (1) knowledge about lung cancer and screening, (2) perceived risk of lung cancer, (3) perceived benefits of lung cancer screening, (4) perceived barriers to lung cancer screening, (5) self-efficacy for lung cancer screening, and (6) perceptions of being adequately prepared to engage in a discussion with their clinician about lung cancer screening.