Facilitation of Information Exchange for Shared Decision Making for Lung Cancer Screening

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ABSTRACT I am a pulmonary critical care physician at the UMass Chan Medical School and a former scholar of the Massachusetts Consortium for Cardiopulmonary Implementation Science program funded by an NIH K12 award. My long-term goal is to be an implementation scientist with expertise in applying health informatics to promote evidence-based practice in lung cancer prevention and control. During my K12, I completed a Master’s in Clinical Investigation and received training in implementation science. However, I still have gaps in my training and seek this K08 award to obtain additional training and mentoring to become a successful independent clinician- scientist. Building upon the single patient strategy that I developed during my K12 project, I propose to develop and pilot test a multi-strategy implementation program called “Facilitation of Information eXchange for Shared Decision Making (FIX-SDM) for Lung Cancer Screening” for this K08. Although lung cancer screening is recommended for high-risk individuals, it is underutilized. The known barriers to lung cancer screening are difficulty identifying lung cancer screening eligible patients, lack of patient awareness, lack of provider knowledge, and need for shared decision making. Because lung cancer screening has both benefits and risks, shared decision making is recommended. However, shared decision making rarely happens in primary care visits since patients and providers often lack the necessary information to conduct shared decision making during the time-constrained visit. FIX-SDM is a multi-strategy technology-assisted implementation program that is designed to support shared decision making and uptake of lung cancer screening by facilitating information exchange in advance of patient visits. Using texting, FIX-SDM will help patients prepare for shared decision making by delivering the information, collecting patient-generated data and providing feedback based on patient- generated data. Leveraging patient-generated data via texting, FIX-SDM will provide the information and tools that primary care providers (PCPs) need for shared decision making in the EHR. During this K08, I will develop the new patient strategies in Aim 1 and the PCP strategies in Aim 2. In Aim 3, I will integrate both patient and PCP strategies of FIX-SDM into the workflow of primary care clinics and conduct a pilot implementation study comparing FIX-SDM and usual care of lung cancer screening uptake. Under the experienced mentorship of Drs. Mazor, Houston, Wiener, Sadasivam, and Crawford, I will carry out the proposed research plan in consort with a structured training plan focusing on mHealth, clinical informatics, patient-generated data, user-centered design, health communication, study design, and statistical and qualitative analysis. At the end of the K08 award, I will be poised to successfully compete for a R01 to conduct a large-scale pragmatic trial of FIX-SDM for LCS to improve the uptake of and longitudinal adherence to annual lung cancer screening. My overall research goals align with NCI’s mission to foster rapid integration of evidenced based practices in cancer prevention and control.