Impact of a Lung Cancer Screening Information Film on Informed Decision-making: A Randomized Trial

Abstract

Rationale: Lung cancer screening has the potential to save lives, but it also carries a risk of potential harms. Explaining the benefits and harms of screening in a way that is balanced and comprehensible to individuals with various levels of education is essential. Although a shared decision-making approach is mandated by the Centers for Medicare & Medicaid Services, there have been no randomized studies to evaluate the impact of different forms of lung screening information. Objectives: To evaluate the impact of a novel information film on informed decision-making in individuals considering participating in lung cancer screening. Methods: A subset of participants from LSUT (Lung Screen Uptake Trial) were randomly allocated either to view the information film and receive a written information booklet or to receive the booklet alone. The primary outcome was the objective knowledge score after intervention. Secondary outcomes included subjective knowledge, decisional conflict, final screening participation, and acceptability of the materials. Univariate and multivariate analyses were performed to determine differences in pre-and postintervention knowledge scores in both groups and between groups for the primary and secondary outcomes. Results: In the final analysis of 229 participants, both groups showed significantly improved subjective and objective knowledge scores after intervention. This improvement was greatest in the film 1 booklet group, where mean objective knowledge improved by 2.16 points (standard deviation [SD] 1.8) compared with 1.84 points (SD 1.9) in the booklet-alone group (b coefficient 0.62; confidence interval, 0.17-1.08; P = 0.007 in the multivariable analysis). Mean subjective knowledge increased by 0.92 points (SD 1.0) in the film 1 booklet group and 0.55 points (SD 1.1) in the booklet-alone group (b coefficient 0.32; CI, 0.05-0.58; P = 0.02 in the multivariable analysis). Decisional certainty was higher in the film 1 booklet (mean 8.5/9 points [SD 1.3], group than in the booklet-alone group (mean 8.2/9 points [SD 1.5]). Both information materials were well accepted, and there were no differences in final screening participation rates between groups. Conclusions: The information film improved knowledge and reduced decisional conflict without affecting lung-screening uptake. Clinical trial registered with clinicaltrials.gov (NCT02558101).

Lung cancer screening: targeting the hard to reach—a review

“…There the fact that an unclear result carries a low overall risk of malignancy are very important. A good understanding of these two areas is key since it can have a positive impact on psychological responses to LCS and false positive results thus promoting participation (52). Some topics can better be dealt with in a careful manner.…”

“…The film would be followed by a session with a health professional to answer any questions and make a decision. The authors suggest that the video (with animations to explain some processes/images) be played in the waiting rooms in a loop so that patients can see it and already have some understanding before the meeting (52).…”

Managing screening-detected subsolid nodules—the Asian perspective

“…(II) In Asia, many institutes have in actuality adopted the concept of shared decision making (SDM) with patients in the management of screened nodules, although this is not formally documented. SDM has, in fact, been adopted in many western medical systems for lung cancer screening (10)(11)(12), including in ongoing randomized trials (13).…”

Lung cancer screening implementation: Complexities and priorities

“…The UK LSUT has tested two recruitment strategies, targeted invitation letters and a film about informed decision-making, in order to overcome participation barriers using rigorous randomized controlled trial methods. 33,44 While these strategies increased participant knowledge, neither resulted in a significant difference in screening uptake between intervention and control groups. However, the uptake of 52% in each arm was much higher than in previous studies, indicating that a Lung Health Check approach could represent a minimum standard.…”

“…The Lung Health Check approach seeks to overcome known practical and psychological barriers to cancer screening by locating mobile LDCT screening vans in shopping centre car parks with immediate access to CT for eligible participants. The UK LSUT has tested two recruitment strategies, targeted invitation letters and a film about informed decision‐making, in order to overcome participation barriers using rigorous randomized controlled trial methods 33,44 . While these strategies increased participant knowledge, neither resulted in a significant difference in screening uptake between intervention and control groups.…”