Scalable decision support and shared decision making for lung cancer screening

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PROJECT SUMMARY Lung cancer is the second most commonly diagnosed cancer in the United States, and it is the leading cause of cancer-related deaths among both men and women. A screening test known as low-dose computed tomography (LDCT) can detect lung cancer early and reduce lung cancer deaths among individuals with a history of heavy smoking, but this test requires patients and their physicians to consider potential benefits and harms that differ according to each patient’s individual risk profile, and less than 5% of eligible patients receive the screening every year. This project will address this urgent need by analyzing patients’ electronic health records, prompting eligible patients and their physicians to consider lung cancer screening, and providing individually-tailored information on the potential benefits and harms of lung cancer screening, so that patients and their physicians can make informed, patient-centered decisions regarding this potentially life-saving test. This project will build off of a stand-alone tool for LDCT shared decision making that has been progressively enhanced by the project team through real-world clinical use, and it will be fully integrated with the electronic health record (EHR) so that it can pull in relevant patient risk data and be seamlessly integrated with routine clinical workflows. This tool, which we call Decision Precision+, will present individually-tailored information on the potential benefits and harms of screening, enabling patients and their physicians to make informed and patient-centered decisions on whether to screen for lung cancer through LDCT testing. Additional tools will also be developed for prompting use of Decision Precision+ for eligible patients and for collecting required smoking history when it is missing. Following its design and development, Decision Precision+ will be implemented and evaluated at the primary care clinics of University of Utah Health. Decision Precision+ will also be made available to other healthcare organizations as a free tool that can be downloaded and used with their own EHR systems. The project team will support the use of Decision Precision+ by other healthcare organizations, so that as many patients as possible can benefit from appropriate LDCT testing and associated reductions in deaths due to lung cancer.