Development and Feasibility Testing of a Lung Cancer Screening Decision Aid

Recent National Lung Screening Trial (NLST) data demonstrated a 20% relative reduction in lung cancer mortality for low dose computed tomography screening as compared to chest X-ray among individuals at high lung cancer risk. Given that lung cancer is the leading cause of cancer death in the United States (US) with an estimated 160,340 deaths predicted for 2012, the data have sparked tremendous interest in lung cancer screening by validating a plausible new tool to reduce the immense burden of lung cancer. However, lung cancer screening carries substantial risks including a high false positive rate, overdiagnosis, adverse psychosocial consequences, and increased radiation exposure. Further, substantial questions persists regarding whether the lung cancer mortality reduction will be realized among individuals who are at high risk of lung cancer due to smoking but do not meet NLST eligibility criteria. Therefore, there is currently no clear best choice for whether a given individual should be screened or not. Lung cancer screening decisions should be well informed and consistent with an individual’s preferences. However, our previous data indicate that individuals who undergo lung cancer screening rarely have a thorough understanding of the risks or benefits. To address this rapidly emerging public health challenge, this research will 1) develop a decision aid (DA) to facilitate informed decision making regarding lung cancer screening in individuals at high risk for lung cancer (i.e., cigarette smokers), and 2) assess the feasibility of DA administration and proposed methods for conducting a future randomized clinical trial (RCT) of DA effectiveness. The specific aims of the currently proposed research are: Aim 1: Develop a DA to help individuals make an informed decision about lung cancer screening that is consistent with their values and preferences. We will develop the DA based on a Knowledge, Empowerment, and Values Clarification framework and guided by previous research, including our own research program on lung cancer screening decisions. Aim 2: Conduct a feasibility trial of the DA among individuals at high risk of lung cancer due to heavy cigarette smoking. We will recruit participants from primary care clinics in Miami Dade County and Kentucky to assess feasibility of 1) delivering the DA intervention and 2) conducting research procedures planned for a future RCT. Our proposed work is highly significant, as the potential risks and limitations of lung cancer screening are substantial, the benefits of screening for populations outside the NLST criteria are uncertain, and millions of Americans will be facing decisions about screening. Our work is also highly innovative, as a lung cancer screening DA can fundamentally improve the way these decisions are made. In addition, integrating a conjoint survey instrument as part of a DA for lung cancer screening is a novel approach to facilitate informed decision making among this large, high-risk population.