Background
Annual lung cancer screening using low dose computed tomography (LDCT) scans is associated with a survival benefit, but is also associated with potential harm. Unlike descriptive probability formats, experienced tasks have been shown to decrease perceptions of rare events. The objective of this study was to compare descriptive versus experienced probability formats on patients’ knowledge, beliefs, endorsement of screening for heavy smokers, and preference (choice predisposition) to undergo screening.
Methods
276 patients attending an outpatient pulmonary practice were randomized to learn about screening using one of three formats: numbers only, numbers + icon arrays, numbers + a set of slides illustrating LDCT scans of 250 people in random order which displayed the number of normal scans, false positive lung nodules, cancers found leading to a life saved, and cancers found leading to death despite treatment.
Results
Knowledge differed between the three formats (p= 0.001) with participants randomized to the numbers + icon array format having the highest knowledge score. Beliefs were more favorable among participants randomized to the numbers + experienced format compared to the numbers + icon array format [Difference between means (95% CI)= 1.6 (0.4–2.8)]. Differences in participants’ endorsement of screening (p= 0.4) and choice predisposition (p= 0.6) across probability format mirrored those of beliefs, but were not statistically significant.
Discussion
Contrary to what we expected, the experienced format increased propensity toward screening compared to the numbers + icon array format as indicated by more favorable beliefs and nonsignificant trends towards stronger choice predisposition and endorsement. Experienced risk formats may not be a practical approach to improve risk communication for patients deciding whether or not to undergo annual lung cancer screening.