Results Summary
What was the research about?
Lung cancer is the leading cause of cancer deaths in the United States. Screening current and former heavy smokers 55 to 77 years of age for lung cancer could prevent more than 12,000 deaths each year. Yet possible harms from screening include false alarms and radiation exposure from the screening test, a CT scan. Many smokers don’t know the benefits and harms of lung cancer screening. Researchers want to develop effective ways to inform smokers about their screening options.
In this study, the research team compared two ways to help people learn about their options for lung cancer screening:
- A brochure that answered common questions about lung cancer screening
- A video decision aid that helped smokers choose between screening options based on what is most important to them
What were the results?
Compared with people who read the brochure, people who watched the video decision aid
- Felt more prepared to talk with their doctor to decide about screening
- Were more aware of their screening options
- Had a better understanding of what benefits and harms of screening mattered most to them
- Had more knowledge about lung cancer and screening options
Who was in the study?
The study included 516 current or former adult heavy smokers. Heavy smokers reported smoking at least one pack of cigarettes a day for 30 years, or an equal amount, such as two packs a day for 15 years. The smokers had called tobacco quitlines, operating in 13 states, for help to quit smoking. Of these smokers, 70 percent were white, 27 percent were African American, and 3 percent were other races. In addition, 62 percent were female and 44 percent had a high school education or less. All smokers were ages 55 to 77 and spoke English.
What did the research team do?
The research team assigned people by chance to one of two groups. In the first group, people received a two-page printed brochure about lung cancer screening. The brochure was from a national lung cancer organization. In the second group, people received a DVD of a video decision aid or a link to view the video online.
The brochure and the decision aid had information on the benefits and harms of screening. The decision aid also guided people to decide which benefits and harms were most important to them.
The team contacted people one week after they received the brochure or decision aid to see how prepared they felt to talk with their doctor to decide about screening. The team also looked to see how aware people were of their screening options and how well they knew which benefits and harms of screening mattered most to them.
The research team also tested people’s knowledge of lung cancer and lung cancer screening one week, three months, and six months after they viewed the brochure or decision aid.
What were the limits of the study?
The study only included people who were interested in quitting smoking and who had expressed interest in lung cancer screening. The results may be different for people not interested in quitting or in lung cancer screening. The team only tested the decision aid with English speakers. Results may differ for smokers who don’t speak English.
Researchers could adapt the decision aid so doctors can use it during visits with patients and test how well it performs in that setting.
How can people use the results?
Tobacco quitlines can reach many people. Quitline staff could refer people to the video decision aid to help them talk with their doctor to see if lung cancer screening is right for them.
Professional Abstract
Objective
To determine whether a video-based decision aid helps heavy smokers feel more prepared, informed, and knowledgeable about lung cancer screening compared with a printed brochure about lung cancer screening
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 516 people ages 55–77 who reported smoking one pack of cigarettes or more per day for 30 years or equivalent and contacted a quitline for smoking cessation services |
| Interventions/ Comparators |
|
| Outcomes |
Primary: preparedness for making a decision about screening, awareness of options for screening, perception of importance of benefits and harms of screening that matter most when making a screening decision Secondary: knowledge of lung cancer and lung cancer screening |
| Timeframe | 1-week follow-up for primary outcomes |
The research team conducted a randomized controlled trial to compare the effectiveness of a video-based decision aid to a printed brochure about lung cancer screening in supporting smokers deciding about lung cancer screening.
The study included 516 adults who reported smoking one pack of cigarettes or more per day for 30 years, or the equivalent. All study participants had called tobacco quitlines operating in one of 13 states for help to quit smoking and also expressed interest in lung cancer screening. Of these participants, 70% were white, 27% were African American, and 3% were other races. In addition, 62% were female, and 44% had a high school education or less. All smokers were ages 55 to 77 and spoke English.
In this study, the research team randomly assigned participants to one of two groups. In the first group, participants received a two-page brochure about lung cancer screening created by a national lung cancer advocacy group. In the second group, participants received a DVD of the video-based decision aid or a link to view the same decision aid online. The video decision aid and brochure both covered the benefits and harms of screening; the decision aid also guided people in deciding which benefits and harms were most important to them.
One week after participants received the brochure or decision aid, the team contacted them by mail or phone to assess how prepared they were to talk with a doctor about a screening decision, their awareness of screening options, and their perceived importance of specific screening benefits and harms. The team also assessed participants’ knowledge of lung cancer and lung cancer screening one week, three months, and six months after they viewed the decision aid or brochure.
Results
One week after participants viewed the materials, those assigned to view the video decision aid were more prepared (p<.0001) to talk with a doctor and make a screening decision, had greater awareness (p<.0001) of their screening options, and had a clearer perception (p<.0001) about which benefits and harms mattered most to them compared with participants who received the brochure.
Participants who used the video decision aid also knew more (p<.0001) about lung cancer and lung cancer screening options compared with those who received the brochure. This difference was significant at the one-week, three-month, and six-month follow-up.
Limitations
The study only included people who expressed interest in quitting smoking and getting lung cancer screening. The results may be different for smokers who are not interested in quitting or lung cancer screening. The research team only measured knowledge outcomes beyond one week postintervention; it is unclear how long other effects of the decision aid are maintained.
The research team did not test the decision aid with people who spoke languages other than English. Results may differ for smokers who do not speak English.
Conclusions and Relevance
Compared with those who received the brochure, participants assigned to view the video decision aid felt more informed about lung cancer screening and their preferences for screening-related benefits and harms, and they were more prepared to talk with their doctor about making a screening decision. Participants who got the decision aid also had greater objective knowledge about screening than those who viewed the brochure. This study demonstrated the decision aid’s potential to help inform lung cancer screening decisions among tobacco quitline callers.
Future Research Needs
Future research could adapt the decision aid for use in a clinical setting and examine its effectiveness in that setting.
Final Research Report
View this project's final research report.
Implementation
Related PCORI Dissemination and Implementation Project
Journal Citations
Article Highlight: A decision aid delivered through tobacco quitlines effectively reaches a screening-eligible population and results in informed decisions about lung cancer screening, according to a PCORI-funded study in Texas. Researchers devised the patient-centered decision aid to help smokers choose between screening options based on what is most important to them, and then compared its effectiveness versus a traditional brochure that answered common questions about screening. As the research team reported in JAMA Network Open, compared to the group that received the brochure, patients who used the decision aid were markedly more prepared to make a screening decision.
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer review identified the following strengths and limitations in the report:
- The reviewers considered the report well written and clear. The investigators added a table describing the video decision aid’s features to add detail about the intervention.
- The reviewers questioned whether the video is a shared decision making tool, or a supportive component of the patient’s visit with the provider when shared decision making occurred. The investigators confirmed that the video they created and tested was a patient decision aid that could help patients prepare for a conversation with their provider. They also added discussion in the background section to distinguish between decision aids and shared decision making.