TORONTO -- Two different strategies for conveying the risks and benefits of lung cancer screening to patients -- one physician-led and the other web-based -- proved equally helpful in terms of patient satisfaction and knowledge retention in a study reported here.
Findings from the pilot study, presented in a late-breaking session at CHEST, the annual meeting of the American College of Chest Physicians, highlight some of the strengths and potential weaknesses of two widely utilized shared decision-making tools for lung cancer screening.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The team compared the and decision aids in the study of 238 patients who underwent lung cancer screening at a single center in Philadelphia.
The Option Grid is a one page handout given to patients prior to meeting with their physician to help guide the discussion about lung cancer screening. The ShouldIScreen.com web-based strategy is an online decision-making tool that does not require a physician consult.
Shared decision-making for lung cancer screening is recommended by the U.S. Preventive Services Task Force, and required for screening reimbursement under Centers for Medicare & Medicaid Services (CMS), noted Shelby Sferra of Temple University in Philadelphia, who presented the .
The trial randomized the lung cancer screening participants to either the Option Grid or the online shared decision-making intervention prior to screening.
A validated shared decision-making assessment tool (CollaboRATE) was used to assess participant experience immediately after screening. Patients were contacted by telephone a week later and answered a series of questions designed to assess knowledge retention about lung cancer and the harms and benefits of screening, including risk factors for lung cancer, follow-up testing, and overdiagnosis.
The participants receiving the Option Grid and the web-based interventions had similar characteristics, and after the intervention, knowledge retention did not differ significantly, with average scores of 62.4% and 64.7% for the online aid and Option Grid, respectively (P=0.43).
Post-intervention/screening patient-satisfaction scores were also similar: 98.6% for the online aid and 97.4% for the Option Grid, P=0.06.
A statistically significant difference was seen, however, in knowledge about potential complications associated with additional testing, with 85% of the Option Grid group answering the question "True or false: extra tests might cause complications?" correctly, compared with 63% of the online group.
"The Option Grid and online programs both have pros and cons," Sferra said. "The main pro of the Option Grid is that it facilitates face-to-face interaction with the physician, and we found this led to greater knowledge about complications."
But this interaction also takes time -- up to 45 minutes per consult, she added said, which may limit the number of screens clinicians can perform.
On the other hand, the web-based program eliminates this time constraint, but requires patients to have some comfort with computers in order to navigate the website; reducing the physician's role in the shared decision-making process may also be seen as a downside.
Asked for her perspective, Nichole T. Tanner, MD, of the Medical University of South Carolina in Charleston, agreed with the latter: "Is an online tool really a shared decision? It is not a conversation with a physician and patient. It is a patient informing on his own."
Disclosures
Sferra and co-authors reported no funding or disclosure information associated with the study.
Primary Source
CHEST
Sferra S, et al "Online decision AID versus option grid in shared decision making prior to lung cancer screening" CHEST 2017; DOI: 10.1016/j.chest.2017.09.013.