ASPO Abstracts
Decisional conflict related to lung cancer screening in current and former smokers
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose: To examine decisional conflict before and after a shared decision-making (
(SDM) intervention for lung cancer screening
Methods: We used electronic medical records (EMR) in one primary care practice to
identify individuals who were current and former smokers and were 55-80 years of age
for contact relative to lung cancer screening. A research assistant contacted and
consented patients by telephone and assessed other screening eligibility criteria
specified by United States Preventive Services Task Force (USPSTF) guidelines,
including have a ≥ 30-pack-year smoking history and had not quit more than 15 years
before. During the call, the research assistant also administered a brief survey, including
the Decisional Conflict Scale (DCS). Nest, a telephone-delivered intervention included a
nurse navigator who guided the patient through an exercise, the Decision Counseling
Program® (or DCP), to elicit patient values and clarify preference to or not to screen. At
30-days, the follow up survey was administered by telephone and medical records were
audited for screening status. Baseline and post-enrollment DCS scores were compared f
for patients who underwent screening.
Results: Among 11 patients with baseline and post-enrollment measures, there was no
statistically significant change in DCS score, mean (SD) score, baseline 28.3 (4.7), post
27.7 (20.1), difference 0.568 (18.2) with p-value=0.92. However, DCS score decreased
among current smokers (n=6): mean (SD) DCS score, baseline 27.6 (4.0), post 20.1
(12.0), difference 7.6 (11.4) with p-value=0.16; while DCS score increased among former
smokers (n=5): mean (SD) score, baseline 29.1 (5.7), post 36.9 (25.1), difference 7.8
(22.4) with p-value=0.48.
Conclusion: These results suggest that current and former smokers may respond d
differently to SDM in terms of decisional conflict. Current smokers may enter an SDM c
conversation with the perception that their risk is high and be reassured that there is a t
test for early detection. In contrast, former smokers may perceive their risk as low and a
awareness of eligibility may challenge their perception. These trends should be further e
explored in a larger population.
Keywords: Lung cancer screening, shared decision making, decisional conflict