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Shared decision making with breast cancer patients – does it work?
218 What is important to patients when deciding about lung cancer screening?
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  1. Daniel Reuland1,2,
  2. Alison Brenner1,2,
  3. Christina Bellinger3,
  4. Richa Bundy4,
  5. Ajay Dharod4,5,
  6. Renée Ferrari2,
  7. Aliza Randazzo5,
  8. Anna Snavely6,
  9. Lindsay Stradtman2,
  10. Robert Volk7,
  11. Elena Wright5,
  12. David Miller4,5
  1. 1Department of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, USA
  2. 2Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
  3. 3Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, USA
  4. 4Department of Internal Medicine, Section of General Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, USA
  5. 5Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, USA
  6. 6Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, USA
  7. 7Department of Health Services Research, MD Anderson Cancer Center, Houston, TX USA

Abstract

Introduction In the US, shared decision-making using a decision aid (DA) is recommended before initiating lung cancer screening (LCS). This study aimed to assess: 1) how patients who are eligible for LCS value the benefits and harms (‘attributes’) of LCS; and 2) whether patients’ most-valued (most important) attribute was associated with their LCS decisions.

Methods LCS-eligible patients were sent an interactive, digital (web-based) LCS DA before a primary care visit. The DA presented benefits and harms of LCS using narration and graphics and included a values clarification exercise (VCE) wherein patients indicated their most important LCS attribute (a potential screening benefit or harm; see table 1) prior to making a screening decision. For analysis, we described the frequencies for most important attributes and screening decisions. We also assessed whether values (gaining benefit vs. avoiding harm) were associated with LCS decisions using the Fisher exact test.

Results Of 353 patients who completed the DA, 240 (68.0%) were female, 282 (79.9%) were White, 57 (16.2%) were Black, and 14 (4.0%) Hispanic/other. Gaining screening benefit (‘avoiding death from lung cancer’) was the most important attribute for 267 (75.6%) participants, while avoiding screening harm was most important for 86 (24.4%) patients (see table 1). The screening decision was ‘yes’ in 205/267 (76%) who prioritized screening benefit compared with 26/86 (30%) who prioritized avoiding harm (p<0.001).

Discussion Three-quarters of LCS-eligible patients who completed a web-based DA valued gaining LCS benefits over avoiding harms.

Conclusion(s) For LCS-eligible patients, values were largely consistent with their screening decisions.

View this table:
Abstract 218 Table 1

Most important lung cancer screening attribute and screening decision for 353 screening- eligible patients who completed a lung cancer screening decision aid and values clarification exercise

https://doi.org/10.1136/bmjebm-2024-SDC.217

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