一项在初级保健中测试肺癌筛查决策辅助工具的前后研究。
A pre-post study testing a lung cancer screening decision aid in primary care.
机构信息
Department of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, CB 7590, Chapel Hill, NC, 27599, USA.
Lineberger Comprehensive Cancer Center, Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, CB 7590, Chapel Hill, NC, 27599, USA.
出版信息
BMC Med Inform Decis Mak. 2018 Jan 12;18(1):5. doi: 10.1186/s12911-018-0582-1.
BACKGROUND
The United States Preventive Services Task Force (USPSTF) issued recommendations for older, heavy lifetime smokers to complete annual low-dose computed tomography (LDCT) scans of the chest as screening for lung cancer. The USPSTF recommends and the Centers for Medicare and Medicaid Services require shared decision making using a decision aid for lung cancer screening with annual LDCT. Little is known about how decision aids affect screening knowledge, preferences, and behavior. Thus, we tested a lung cancer screening decision aid video in screening-eligible primary care patients.
METHODS
We conducted a single-group study with surveys before and after decision aid viewing and medical record review at 3 months. Participants were active patients of a large US academic primary care practice who were current or former smokers, ages 55-80 years, and eligible for screening based on current screening guidelines. Outcomes assessed pre-post decision aid viewing were screening-related knowledge score (9 items about screening-related harms of false positives and overdiagnosis, likelihood of benefit; score range = 0-9) and preference (preferred screening vs. not). Screening behavior measures, assessed via chart review, included provider visits, screening discussion, LDCT ordering, and LDCT completion within 3 months.
RESULTS
Among 50 participants, knowledge increased from pre- to post-decision aid viewing (mean = 2.6 vs. 5.5, difference = 2.8; 95% CI 2.1, 3.6, p < 0.001). Preferences across the overall sample remained similar such that 54% preferred screening at baseline and 50% after viewing; however, 28% of participants changed their preference (to or away from screening) from baseline to after viewing. We assessed screening behavior for 36 participants who had a primary care visit during the 3-month period following enrollment. Eighteen of 36 preferred screening after decision aid viewing. Of these 18, 10 discussed screening, 8 had a test ordered, and 6 completed LDCT. Among the 18 who preferred no screening, 7 discussed screening, 5 had a test ordered, and 4 completed LDCT.
CONCLUSIONS
In primary care patients, a lung cancer screening decision aid improved knowledge regarding screening-related benefits and harms. Screening preferences and behavior were heterogeneous.
TRIAL REGISTRATION
This study is registered at www.clinicaltrials.gov . NCT03077230 (registered retrospectively,November 22, 2016).
背景
美国预防服务工作组（USPSTF）发布了建议，要求年龄较大、终生吸烟量大的老年人每年进行低剂量计算机断层扫描（LDCT）胸部筛查，作为肺癌筛查手段。USPSTF 建议并由医疗保险和医疗补助服务中心要求，使用肺癌筛查决策辅助工具，对所有符合年度 LDCT 筛查条件的人进行共同决策。对于决策辅助工具如何影响筛查知识、偏好和行为，我们知之甚少。因此，我们在符合筛查条件的初级保健患者中测试了一种肺癌筛查决策辅助工具视频。
方法
我们进行了一项单组研究，在观看决策辅助工具前后进行了调查，并在 3 个月时进行了病历回顾。参与者是一家大型美国学术性初级保健机构的活跃患者，他们是当前或以前的吸烟者，年龄在 55-80 岁之间，并且根据当前的筛查指南符合筛查条件。在观看决策辅助工具前后评估的结果是筛查相关知识评分（9 项关于筛查假阳性和过度诊断相关危害以及获益可能性的问题；评分范围为 0-9）和偏好（筛查与不筛查）。通过病历回顾评估的筛查行为措施包括就诊、筛查讨论、LDCT 订购和 3 个月内完成 LDCT。
结果
在 50 名参与者中，知识从观看决策辅助工具前到后有所增加（平均值为 2.6 对 5.5，差异为 2.8；95%CI 2.1，3.6，p<0.001）。整个样本的偏好仍然相似，即 54%的人在基线时选择筛查，而 50%的人在观看后选择筛查；然而，28%的参与者从基线到观看后改变了他们的偏好（选择或不选择筛查）。我们评估了在入组后 3 个月内进行了初级保健就诊的 36 名参与者的筛查行为。在观看决策辅助工具后，有 18 名参与者表示更倾向于筛查。在这 18 名参与者中，有 10 名讨论了筛查，8 名进行了测试订购，6 名完成了 LDCT。在 18 名不选择筛查的参与者中，有 7 名讨论了筛查，5 名进行了测试订购，4 名完成了 LDCT。
结论
在初级保健患者中，肺癌筛查决策辅助工具提高了他们对筛查相关获益和危害的了解。筛查偏好和行为存在异质性。
试验注册
本研究在 www.clinicaltrials.gov 上注册。NCT03077230（2016 年 11 月 22 日，注册回顾性）。
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