Using a Patient Decision Aid Video to Assess Current and Former Smokers' Values About the Harms and Benefits of Lung Cancer Screening With Low-Dose Computed Tomography

Aubri S Hoffman, Andrea P Hempstead, Ashley J Housten, Vincent F Richards, Lisa M Lowenstein, Viola B Leal, Robert J Volk, Aubri S Hoffman, Andrea P Hempstead, Ashley J Housten, Vincent F Richards, Lisa M Lowenstein, Viola B Leal, Robert J Volk

Abstract

Background. Recent policy changes require discussing the potential benefits and harms of lung cancer screening with low-dose computed tomography. This study explored how current and former smokers value potential benefits and harms after watching a patient decision aid, and their screening intentions. Methods. Current or former smokers (quit within 15 years) with no history of lung cancer watched the decision aid and responded to items assessing the value of potential benefits and harms in their decision making, and their screening intentions. Results. After viewing the decision aid, participants (n = 30; mean age 61.5 years, mean 30.4 pack-year history) were well-informed (mean 80.5% correct responses) and rated anticipated regret and finding cancer early as highly important in their decision (medians >9 out of 10), along with moderate but variable concerns about false positives, overdiagnosis, and radiation exposure (medians 7.0, 6.0, and 5.0, respectively). Most participants (90.0% to 96.7%) felt clear about how they personally valued the potential benefits and harms and prepared for decision making (mean 86.7 out of 100, SD = 21.3). After viewing the decision aid, most participants (90%) intended to discuss screening with their doctor. Limitations. The study is limited to current and former smokers enrolled in a tobacco treatment program, and it may not generalize to other patient populations. Conclusions. The majority of current and former smokers were strongly concerned about anticipated regret and finding cancer early, while concerns about radiation exposure, false positives, and overdiagnosis were variable. After viewing the decision aid, current and former smokers reported strong preparedness and intentions to talk with their doctor about lung cancer screening with low-dose computed tomography.

Keywords: decision making; decision support; lung neoplasms; smokers; tomography x-ray computed.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Selected screen shots from the patient decision aid video. (A) mortality benefit from annual screening with low-dose computed tomography, (B) pack-year calculation, (C) radiation exposure contextualized, (D) comparing benefits and harms of lung cancer screening with low-dose computed tomography.
Figure 2
Figure 2
Current and former smokers’ ratings of the value (i.e., importance) of potential risks of lung cancer screening with low-dose computed tomography; medians, interquartile ranges, and outliers. The box represents the interquartile range (IQR), with the center line in the box representing the median value; whiskers representing the data points within 1.5 IQR on the upper and lower ends; and solid dots representing outliers that are values outside 1.5 IQR. For Find Early, responses are clustered at 10, represented by the bolded bar.

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