A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis (Preprint)

Abstract

BACKGROUND Web based tools developed to facilitate a Shared Decision Making (SDM) process may facilitate implementation of lung cancer screening (LCS), an evidence based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that impact the benefit and potential harms of LCS, so may value a Veteran centric LCS SDM too OBJECTIVE To develop and conduct usability testing of a LCS Decision Tool (LCSDecTool) designed for Veterans receiving care at a Veteran Affairs Medical Center (VAMC). METHODS A user-centered design approach was undertaken to develop the LCSDecTool. Usability of a prototype was assessed among 18 Veterans from two VA sites. Usability of a high fidelity version was assessed among 43 Veterans as part of a clinical trial. Outcomes included the System Usability Scale (SUS), the End User Computer Satisfaction (EUCS), and the Patient Engagement (PE) scale. Qualitative data from observations and short interviews with users were analyzed and themes pertaining to usability identified. RESULTS The mean (SD) in the pilot clinical trial (n=43) for the SUS (potential range 0 [low] to 100 [high] was 65.76 [15.23]); EUCS (potential range 1 [low] to 5 [high] was 3.91 [0.95]); and PE (potential range 1[low) to 5 [high] was 4.62 [0.67]). Time to completion of the LCSDecTool in minutes (median, intra-quartile range) was (13, 10-16). Emerging themes included: 1) a baseline gap in awareness of LCS with knowledge gained from using the LCSDecTool, 2) an interest in details about the LCS process, 3) the LCSDecTool was easy to use overall but specific navigation challenges identified, and 4) difficulty in understanding medical terminology. CONCLUSIONS The LCSDecTool demonstrates a good level of usability among Veterans when testing in the context of clinical care. Study findings will inform further modifications of the tool, including shortening the length and simplifying language. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT02899754