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260 Implementing telehealth decision coaching delivered by patient navigators for lung cancer screening
  1. Naomi QP Tan1,2,
  2. Elisa E Douglas3,
  3. Richard M Hoffman3,
  4. Anita Y Kinney1,5,
  5. Robert J Volk3,
  6. Lisa M Lowenstein3
  1. 1Rutgers Cancer Institute of New Jersey, New Brunswick, NJ USA
  2. 2Division of Medical Oncology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick NJ USA
  3. 3Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, USA
  4. 4Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
  5. 5Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA


Introduction To overcome barriers to implementing mandated shared decision-making (SDM) visits for lung cancer screening (LCS), we evaluated telehealth decision coaching delivered by trained lay navigators in a cluster randomized trial. Delivering SDM with high fidelity is essential to ensuring that patients make informed LCS decisions.

Methods Recordings of coaching sessions were coded for fidelity by two independent raters. A checklist was used to evaluate navigators’ skills in three areas – 1) telehealth technical skills (4 items coded as Yes/No, e.g., shared/stopped sharing their screen), 2) content of SDM conversations (16 items coded as Yes/No, e.g., addressed benefits and harms), and 3) decision coaching skills (6 items coded as Not at All, Somewhat, or Very, e.g., following-up on patient’s concerns, checking patient’s understanding of content).

Results We analyzed 30 decision coaching sessions conducted by eight navigators. Navigators initially had technical problems that required additional training, such as not sharing the correct screen. In most sessions (n=28), navigators accurately covered the content. However, 2 navigators skipped information resulting in omission of key facts (e.g. importance of not smoking). In 56.7% of the sessions (n=17), navigators accomplished all decision coaching skills. Common weaknesses included not validating patient’s concerns, not probing for information, and not presenting a balance of benefits and harms. Navigators sometimes relied on conventional wisdom (e.g., early detection is always best) rather than following the script when answering questions.

Discussion Lay navigators can educate patients on key facts of LCS with good fidelity as long as they followed the script. There was more variation in decision coaching skills. Training navigators to present a balance of benefits and harms for LCS is essential to overcome conventional wisdom about screening.

Conclusions Lay navigators can deliver telehealth decision coaching with high fidelity using a script with support and training.

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