St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia.
Curtin Medical School, Curtin University, Bentley, Western Australia, Australia.
Transl Behav Med. 2020 May 20;10(2):404-412. doi: 10.1093/tbm/ibz029.
Lung cancer screening of high-risk individuals with computed tomography is a promising intervention to reduce lung cancer mortality. Patient Decision Aids (PtDAs) may assist eligible individuals assess the risks and benefits associated with screening. Screening preference is high among lower-risk, screening-ineligible individuals and strategies are needed to reduce screening demand among this group. We developed and evaluated a resource comprising a recruitment pamphlet combined with either a PtDA for screening-eligible individuals or an education pamphlet for screening-ineligible individuals. Quasi-experimental pre-post pamphlet exposure design. Ever-smokers aged 55-80 years attending hospital outpatient clinics were invited. Among screening-eligible participants, the assessed outcome was change in score on the Decisional Conflict Scale (DCS). Among screening-ineligible participants, the assessed outcomes were change in screening preference. In the study 51% (55/107) of invited individuals participated, with mean ± standard deviation age 66.9 ± 6.4 years, 53% (29/55) male, and 65% (36/55) eligible for screening. Median (interquartile range) DCS among screening-eligible participants reduced from 28.9 (22.7-45.3) pre-PtDA to 25 (1.6-29.7) post-PtDA (p < .001), but there was no significant change in the proportion that reached the accepted threshold for decisional certainty (DCS < 25, 10/36 [28%] pre-exposure vs. 14/36 [39%] post-exposure, p = .1). Screening preference among screening-ineligible individuals reduced after viewing the screening-ineligible brochure (pre-exposure median of "Prefer" to post-exposure median of "Unsure," p = .001). Our consumer information pamphlets about lung cancer screening may reduce decisional conflict and improve alignment of screening preference with eligibility.
肺癌高危人群的计算机断层扫描筛查是降低肺癌死亡率的一种有前途的干预措施。患者决策辅助工具（PtDAs）可以帮助符合条件的个人评估筛查相关的风险和益处。在低风险、不符合筛查条件的人群中，筛查偏好率较高，需要采取策略来降低这部分人群的筛查需求。我们开发并评估了一种资源，该资源包括一份招募手册，以及一份针对符合筛查条件的个体的 PtDA 或一份针对不符合筛查条件的个体的教育手册。准实验性的前后宣传册暴露设计。邀请年龄在 55-80 岁之间、在医院门诊就诊的曾吸烟者参加。在符合筛查条件的参与者中，评估结果是决策冲突量表（DCS）得分的变化。在不符合筛查条件的参与者中，评估结果是筛查偏好的变化。在这项研究中，邀请了 107 人，51%（55/107）的人参加，平均年龄为 66.9 ± 6.4 岁，53%（29/55）为男性，65%（36/55）符合筛查条件。在符合筛查条件的参与者中，DCS 的中位数（四分位距）从 PtDA 前的 28.9（22.7-45.3）降至 PtDA 后的 25（1.6-29.7）（p<0.001），但达到决策确定性可接受阈值（DCS<25）的比例没有显著变化（PtDA 前为 10/36[28%]，PtDA 后为 14/36[39%]，p=0.1）。在观看了不符合筛查条件的宣传册后，不符合筛查条件的个体的筛查偏好降低（暴露前的“偏好”中位数与暴露后的“不确定”中位数相比，p=0.001）。我们关于肺癌筛查的消费者信息宣传册可能会降低决策冲突，并使筛查偏好与资格更一致。
