Informed Decision Making for Veterans Considering Lung Cancer Screening

背景 肺癌是美国最常见的癌症相关死亡原因。退伍军人面临着 严重的疾病负担，部分原因是吸烟率高于普通人群。的范例 肺癌控制正在发生变化，肺癌筛查的作用正在显现。最近的一项临床试验发现 对年龄在55岁到74岁之间、至少有30年吸烟史的人进行筛查可以减少肺脏 癌症死亡率。尽管证据确凿，但调查结果的翻译仍然存在问题。 包括退伍军人在内的真实世界环境。目前尚不清楚个人将如何权衡这一好处， 与肺癌筛查相关的潜在危害和不确定性，以及筛查计划是否 将减少肺癌结果中长期存在的种族差异。 目标 此试点研究的目标是1)确定如何最好地传达 与退伍军人肺癌筛查相关的不确定性，2)开发和管理联合 分析实验以评估患者对肺癌筛查的偏好，以及3)开发一种 供考虑肺癌的退伍军人使用的共享决策工具的概念框架 放映。 方法 这些目标将通过混合方法方法和 跨学科的调查团队。研究团队包括肺疾病临床领域的专家。 医学、普通内科、放射学、社会科学家和健康差距研究人员。 将在目标人群中进行结构化访谈，以探讨退伍军人如何看待肺癌 筛选，评估相关的好处和危害，并了解统计、证据和随机 与预期结果相关的不确定性。将开展联合分析实验以评估 退伍军人人群对肺癌筛查的偏好。联合分析实验将是 旨在确定退伍军人分配给各种属性的部分价值效用和重要性权重 筛查包括降低死亡率、风险和假阳性检测率。联合分析实验 还将被设计用来检查偏好是否因种族而异。结构化访谈的结果 联合分析将为肺癌筛查共享决策原型的开发提供信息 制作工具。 影响 肺癌控制的模式正在发生变化，在高危患者中进行筛查的作用正在显现。 肺癌筛查计划的实施需要知情决策的工具和 更好地了解不同社会经济背景的退伍军人如何将利益、伤害和 与这一干预相关的不确定性。该试点项目将提供有关以下方面的初步数据 交际策略的可行性和可接受性以及基于理论的偏好的使用 退伍军人中的评估工具。调查人员将与退伍军人健康管理局合作 国家健康促进中心(NCP)传播在该研究计划中开发的工具。

Background Lung cancer is the most common cause of cancer related death in the United States. Veterans face a significant burden of disease due in part to higher rates of smoking than general populations. The paradigm of lung cancer control is changing with an emerging role for lung cancer screening. A recent clinical trial found that screening individuals aged 55 to 74 who had at least a 30 pack year history of smoking decreased lung cancer mortality. Despite the strength of this evidence, questions remain regarding the translation of findings to the real world setting including Veteran populations. It is unclear how individuals will weigh the benefit, potential harms, and uncertainties associated with lung cancer screening and whether a screening program would reduce long standing racial disparities in lung cancer outcomes. Objectives The objectives of this pilot study are 1) to identify how best to communicate the benefits, harms, and uncertainties associated with lung cancer screening to Veterans, 2) to develop and administer a conjoint analysis experiment to asses patient preferences regarding lung cancer screening, and 3) to develop a conceptual framework for a shared decision making tool for use among Veterans considering lung cancer screening. Methods These objectives will be accomplished through a mixed methods approach and collaborative efforts of an interdisciplinary team of investigators. The research team includes experts in the clinical fields of pulmonary medicine, general internal medicine, and radiology, social scientists, and health disparities researchers. Structured interviews will be conducted in the target population to explore how Veterans view lung cancer screening, value the associated benefits and harms, and understand the statistical, evidentiary, and stochastic uncertainty associated with expected outcomes. A conjoint analysis experiment will be developed to evaluate preference for lung cancer screening in the Veteran population. The conjoint analysis experiment will be designed to ascertain part-worth utilities and importance weights Veterans assign to various attributes of screening including mortality risk reduction and rates of false positive tests. The conjoint analysis experiment will also be designed to examine whether preferences vary by race. Findings from the structured interviews and conjoint analysis will inform the development of a prototype for a lung cancer screening shared decision making tool. Impact The paradigm for lung cancer control is changing with an emerging role for screening among high risk patients. The implementation of a lung cancer screening program required tools for informed decision making and a better understanding of how Veterans across socioeconomic backgrounds will integrate benefits, harms, and uncertainties associated with this intervention. This pilot project will provide preliminary data regarding the feasibility and acceptability of communication strategies and the use of a theoretically based preference assessment tool in VA populations. The investigators will work with the Veterans Health Administration National Center for Health Promotion (NCP) to disseminate the tools developed in this research program.