Disseminating LCS through Shared Decision Making: A Web-Based CE Intervention for Primary Care Providers

The National Lung Screening Trial (NLST) revealed a reduction in lung cancer mortality that has led to draft recommendations by the US Preventive Services Task Force (USPSTF) in favor of LDCT-based lung cancer in selected high-risk groups. Provider organizations also recommend that high-risk individuals be engaged in a process of shared decision making (SDM) about LCS. The goal of SDM is to ensure patients understand potential benefits, harms, and uncertainties related to screening, and make screening decisions based on evidence and their personal values and preferences. Our preliminary data shows that there is a substantial need to raise awareness of LCS among primary care providers (PCPs) and screening-eligible individuals. PCPs are the most influential source of cancer screening recommendations, and they are likely to play a pivotal role in disseminating LCS. However, our evidence shows that PCPs do not have adequate knowledge of the potential benefits and harms of LCS and they struggle to implement SDM with regard to cancer screening, undermining optimal LCS implementation. Given limited knowledge of LCS among PCPs and known barriers to achieving SDM in clinical practice, there is a need for provider-targeted interventions to promote LCS knowledge and facilitate SDM regarding LCS. This project will develop and evaluate a web-based and broadly disseminable intervention designed to promote SDM about LCS. The intervention builds on pilot data from our recently developed continuing education program targeting PCPs. Web-based continuing education programs can both communicate accurate information about LCS to PCPs and train them effectively in the skills needed to facilitate SDM with patients considering LCS. In Phase I, this project will develop and test the usability of a web-based continuing education program (LCS-CE) designed to inform PCPs about the evidence supporting LCS, new LCS guidelines, and implementation of SDM regarding LCS, incorporating engaging text, audio, and video vignettes examples. In Phase II, investigators will conduct a two group parallel randomized trial comparing the impact of LCS-CE against a web-based delivery of the USPSTF LCS guidelines for PCPs. We hypothesize that the LCS-CE program will lead to greater knowledge of LCS, superior self-efficacy in SDM skills, more favorable attitudes toward SDM for LCS, and greater implementation of SDM for LCS. This T3 translational study has the potential to facilitate implementation of LCS and fulfill the promise of reduced lung cancer mortality in Kentucky and nationally.