Carter-Harris Lisa, Comer Robert Skipworth, Goyal Anurag, Vode Emilee Christine, Hanna Nasser, Ceppa DuyKhanh, Rawl Susan M
Science of Nursing Care Department, Indiana University School of Nursing, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, United States.
Cancer Prevention & Control Program, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, United States.
JMIR Res Protoc. 2017 Nov 16;6(11):e225. doi: 10.2196/resprot.8694.
Awareness of lung cancer screening remains low in the screening-eligible population, and when patients visit their clinician never having heard of lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Therefore, methods to effectively support both patients and clinicians to engage in these important discussions are essential. To facilitate shared decision making about lung cancer screening, effective methods to prepare patients to have these important discussions with their clinician are needed.
Our objective is to develop a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards instrument version 4.0 that will support shared decision making in lung cancer screening decisions.
Using a 3-phase process, we will develop and test a prototype of a computer-tailored decision support tool in a sample of lung cancer screening-eligible individuals. In phase I, we assembled a community advisory board comprising 10 screening-eligible individuals to develop the prototype. In phase II, we recruited a sample of 13 screening-eligible individuals to test the prototype for usability, acceptability, and satisfaction. In phase III, we are conducting a pilot randomized controlled trial (RCT) with 60 screening-eligible participants who have never been screened for lung cancer. Outcomes tested include lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), perception of being prepared to engage in a patient-clinician discussion about lung cancer screening, occurrence of a patient-clinician discussion about lung cancer screening, and stage of adoption for lung cancer screening.
Phases I and II are complete. Phase III is underway. As of July 15, 2017, 60 participants have been enrolled into the study, and have completed the baseline survey, intervention, and first follow-up survey. We expect to have results by December 31, 2017 and to have data analysis completed by March 1, 2018.
Results from usability testing indicate that the computer-tailored decision support tool is easy to use, is helpful, and provides a satisfactory experience for the user. At the conclusion of phase III (pilot RCT), we will have preliminary effect sizes to inform a future fully powered RCT on changes in (1) knowledge about lung cancer and screening, (2) perceived risk of lung cancer, (3) perceived benefits of lung cancer screening, (4) perceived barriers to lung cancer screening, (5) self-efficacy for lung cancer screening, and (6) perceptions of being adequately prepared to engage in a discussion with their clinician about lung cancer screening.
在符合筛查条件的人群中，肺癌筛查的知晓率仍然很低，当患者就诊时从未听说过肺癌筛查，进行共同决策以做出明智的决定可能是一项挑战。因此，有效支持患者和临床医生参与这些重要讨论的方法至关重要。为了促进肺癌筛查的共同决策，需要有效的方法让患者为与临床医生进行这些重要讨论做好准备。
我们的目标是开发一种符合国际患者决策辅助标准工具第4.0版认证标准的计算机定制决策支持工具，以支持肺癌筛查决策中的共同决策。
我们将通过一个三阶段的过程，在符合肺癌筛查条件的个体样本中开发和测试计算机定制决策支持工具的原型。在第一阶段，我们组建了一个由10名符合筛查条件的个体组成的社区咨询委员会来开发原型。在第二阶段，我们招募了13名符合筛查条件的个体样本，以测试原型的可用性、可接受性和满意度。在第三阶段，我们正在对60名从未接受过肺癌筛查的符合筛查条件的参与者进行一项试点随机对照试验（RCT）。测试的结果包括肺癌和筛查知识、肺癌筛查健康信念（感知风险、感知益处、感知障碍和自我效能）、对准备好与临床医生就肺癌筛查进行讨论的认知、关于肺癌筛查的患者与临床医生讨论的发生情况以及肺癌筛查的采用阶段。
第一阶段和第二阶段已经完成。第三阶段正在进行中。截至2017年7月15日，已有60名参与者纳入研究，并完成了基线调查、干预和首次随访调查。我们预计在2017年12月31日前获得结果，并在2018年3月1日前完成数据分析。
可用性测试的结果表明，计算机定制决策支持工具易于使用、有帮助，并且为用户提供了令人满意的体验。在第三阶段（试点RCT）结束时，我们将获得初步效应大小，为未来一项关于以下方面变化的全面RCT提供信息：（1）肺癌和筛查知识；（2）肺癌的感知风险；（3）肺癌筛查的感知益处；（4）肺癌筛查的感知障碍；（5）肺癌筛查的自我效能；（6）对准备好与临床医生就肺癌筛查进行讨论的认知。
