Informed Decision Making for Veterans Considering Lung Cancer Screening

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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.