PDF(Pubmed)
Abstract：
Guidelines recommend shared decision-making prior to initiating lung cancer screening (LCS). However, evidence is lacking on how to best implement shared decision-making in clinical practice.
To evaluate the impact of an LCS Decision Tool (LCSDecTool) on the quality of decision-making and LCS uptake.
This randomized clinical trial enrolled participants at Veteran Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut, from March 18, 2019, to September 29, 2021, with follow-up through July 18, 2022. Individuals aged 55 to 80 years with a smoking history of at least 30 pack-years who were current smokers or had quit within the past 15 years were eligible to participate. Individuals with LCS within 15 months were excluded. Of 1047 individuals who were sent a recruitment letter or had referred themselves, 140 were enrolled.
A web-based patient- and clinician-facing LCS decision support tool vs an attention control intervention.
The primary outcome was decisional conflict at 1 month. Secondary outcomes included decisional conflict immediately after intervention and 3 months after intervention, knowledge, decisional regret, and anxiety immediately after intervention and 1 and 3 months after intervention and LCS by 6 months.
Of 140 enrolled participants (median age, 64.0 [IQR, 61.0-69.0] years), 129 (92.1%) were men and 11 (7.9%) were women. Of 137 participants with data available, 75 (53.6%) were African American or Black and 62 (44.3%) were White; 4 participants (2.9%) also reported Hispanic or Latino ethnicity. Mean decisional conflict score at 1 month did not differ between the LCSDecTool and control groups (25.7 [95% CI, 21.4-30.1] vs 29.9 [95% CI, 25.6-34.2], respectively; P = .18). Mean LCS knowledge score was greater in the LCSDecTool group immediately after intervention (7.0 [95% CI, 6.3-7.7] vs 4.9 [95% CI, 4.3-5.5]; P < .001) and remained higher at 1 month (6.3 [95% CI, 5.7-6.8] vs 5.2 [95% CI, 4.5-5.8]; P = .03) and 3 months (6.2 [95% CI, 5.6-6.8] vs 5.1 [95% CI, 4.4-5.8]; P = .01). Uptake of LCS was greater in the LCSDecTool group at 6 months (26 of 69 [37.7%] vs 15 of 71 [21.1%]; P = .04).
In this randomized clinical trial of an LCSDecTool compared with attention control, no effect on decisional conflict occurred at 1 month. The LCSDecTool used in the primary care setting did not yield a significant difference in decisional conflict. The intervention led to greater knowledge and LCS uptake. These findings can inform future implementation strategies and research in LCS shared decision-making.
ClinicalTrials.gov Identifier: NCT02899754.
To evaluate the impact of an LCS Decision Tool (LCSDecTool) on the quality of decision-making and LCS uptake.
This randomized clinical trial enrolled participants at Veteran Affairs Medical Centers in Philadelphia, Pennsylvania; Milwaukee, Wisconsin; and West Haven, Connecticut, from March 18, 2019, to September 29, 2021, with follow-up through July 18, 2022. Individuals aged 55 to 80 years with a smoking history of at least 30 pack-years who were current smokers or had quit within the past 15 years were eligible to participate. Individuals with LCS within 15 months were excluded. Of 1047 individuals who were sent a recruitment letter or had referred themselves, 140 were enrolled.
A web-based patient- and clinician-facing LCS decision support tool vs an attention control intervention.
The primary outcome was decisional conflict at 1 month. Secondary outcomes included decisional conflict immediately after intervention and 3 months after intervention, knowledge, decisional regret, and anxiety immediately after intervention and 1 and 3 months after intervention and LCS by 6 months.
Of 140 enrolled participants (median age, 64.0 [IQR, 61.0-69.0] years), 129 (92.1%) were men and 11 (7.9%) were women. Of 137 participants with data available, 75 (53.6%) were African American or Black and 62 (44.3%) were White; 4 participants (2.9%) also reported Hispanic or Latino ethnicity. Mean decisional conflict score at 1 month did not differ between the LCSDecTool and control groups (25.7 [95% CI, 21.4-30.1] vs 29.9 [95% CI, 25.6-34.2], respectively; P = .18). Mean LCS knowledge score was greater in the LCSDecTool group immediately after intervention (7.0 [95% CI, 6.3-7.7] vs 4.9 [95% CI, 4.3-5.5]; P < .001) and remained higher at 1 month (6.3 [95% CI, 5.7-6.8] vs 5.2 [95% CI, 4.5-5.8]; P = .03) and 3 months (6.2 [95% CI, 5.6-6.8] vs 5.1 [95% CI, 4.4-5.8]; P = .01). Uptake of LCS was greater in the LCSDecTool group at 6 months (26 of 69 [37.7%] vs 15 of 71 [21.1%]; P = .04).
In this randomized clinical trial of an LCSDecTool compared with attention control, no effect on decisional conflict occurred at 1 month. The LCSDecTool used in the primary care setting did not yield a significant difference in decisional conflict. The intervention led to greater knowledge and LCS uptake. These findings can inform future implementation strategies and research in LCS shared decision-making.
ClinicalTrials.gov Identifier: NCT02899754.
摘要：
■指南建议在开始肺癌筛查（LCS）之前共同决策。然而,缺乏关于如何在临床实践中最好地实施共同决策的证据.
■评估LCS决策工具（LCSDecTool）对决策质量和LCS吸收的影响。
■这项随机临床试验招募了费城退伍军人事务医疗中心的参与者，宾夕法尼亚州;密尔沃基,威斯康星州；和西黑文，康涅狄格州,从2019年3月18日至2021年9月29日，后续至2022年7月18日。年龄在55至80岁，吸烟史至少为30包-年，目前吸烟者或在过去15年内戒烟的个人有资格参加。排除15个月内患有LCS的个体。在1047个人中，他们收到了招募信或推荐了自己，140人报名。
■基于网络的面向患者和临床医生的LCS决策支持工具与注意力控制干预。
■主要结果是1个月时的决策冲突。次要结果包括干预后立即和干预后3个月的决策冲突，知识,决定性的遗憾，干预后即刻和干预后1个月和3个月和6个月的LCS和焦虑。
■140名注册参与者(平均年龄，64.0[IQR，61.0-69.0]年)，129名（92.1％）为男性，11名（7.9％）为女性。在有数据的137名参与者中，75（53.6％）是非裔美国人或黑人，62（44.3％）是白人；4名参与者（2.9％）还报告了西班牙裔或拉丁裔种族。LCSDecTool组和对照组在1个月时的平均决策冲突评分没有差异（25.7[95％CI，21.4-30.1]vs29.9[95％CI，25.6-34.2]，分别为；P=.18）。LCSDecTool组的平均LCS知识得分在干预后立即更高（7.0[95％CI，6.3-7.7]vs4.9[95％CI，4.3-5.5]；P<.001），并且在1个月（6.3[95％CI，5.7-6.8]vs5.2[95％CI，4.5-5.8]；P=0.03）和3个月（6.2[95％CI，5.6-6.8]vs5.1[95％CI，LCSDecTool组在6个月时LCS的摄取更大（69个中的26个[37.7%]对71个中的15个[21.1%]；P=.04）。
■在这项LCSDecTool与注意对照的随机临床试验中，1个月时对决策冲突无影响。在初级保健环境中使用的LCSDecTool在决策冲突中没有产生显着差异。干预导致更多的知识和LCS吸收。这些发现可以为LCS共享决策中的未来实施策略和研究提供信息。
■ClinicalTrials.gov标识符：NCT02899754。
■评估LCS决策工具（LCSDecTool）对决策质量和LCS吸收的影响。
■这项随机临床试验招募了费城退伍军人事务医疗中心的参与者，宾夕法尼亚州;密尔沃基,威斯康星州；和西黑文，康涅狄格州,从2019年3月18日至2021年9月29日，后续至2022年7月18日。年龄在55至80岁，吸烟史至少为30包-年，目前吸烟者或在过去15年内戒烟的个人有资格参加。排除15个月内患有LCS的个体。在1047个人中，他们收到了招募信或推荐了自己，140人报名。
■基于网络的面向患者和临床医生的LCS决策支持工具与注意力控制干预。
■主要结果是1个月时的决策冲突。次要结果包括干预后立即和干预后3个月的决策冲突，知识,决定性的遗憾，干预后即刻和干预后1个月和3个月和6个月的LCS和焦虑。
■140名注册参与者(平均年龄，64.0[IQR，61.0-69.0]年)，129名（92.1％）为男性，11名（7.9％）为女性。在有数据的137名参与者中，75（53.6％）是非裔美国人或黑人，62（44.3％）是白人；4名参与者（2.9％）还报告了西班牙裔或拉丁裔种族。LCSDecTool组和对照组在1个月时的平均决策冲突评分没有差异（25.7[95％CI，21.4-30.1]vs29.9[95％CI，25.6-34.2]，分别为；P=.18）。LCSDecTool组的平均LCS知识得分在干预后立即更高（7.0[95％CI，6.3-7.7]vs4.9[95％CI，4.3-5.5]；P<.001），并且在1个月（6.3[95％CI，5.7-6.8]vs5.2[95％CI，4.5-5.8]；P=0.03）和3个月（6.2[95％CI，5.6-6.8]vs5.1[95％CI，LCSDecTool组在6个月时LCS的摄取更大（69个中的26个[37.7%]对71个中的15个[21.1%]；P=.04）。
■在这项LCSDecTool与注意对照的随机临床试验中，1个月时对决策冲突无影响。在初级保健环境中使用的LCSDecTool在决策冲突中没有产生显着差异。干预导致更多的知识和LCS吸收。这些发现可以为LCS共享决策中的未来实施策略和研究提供信息。
■ClinicalTrials.gov标识符：NCT02899754。
