Department of Family and Community Medicine, Christiana Care Health System, Wilmington, DE, USA.
Office of Health Equity, Christiana Care Health System, Wilmington, DE, USA.
J Cancer Educ. 2020 Aug;35(4):766-773. doi: 10.1007/s13187-019-01528-z.
The national rate of lung cancer screening, approximately 3-5%, is too low and strategies which include shared decision-making and increase screening are needed. A feasibility study in one large primary care practice of telephone-based delivery of decision support via an online tool, the Decision Counseling Program© (DCP) was administered to patients eligible for lung cancer screening according to USPSTF screening guidelines. We collected data on demographics, decisional conflict, and conducted chart audits to ascertain screening. From electronic medical record data, we identified 829 age-eligible current or former smokers. Of the 297 individuals reached, 54 were eligible and 28 were recruited to the study and 20 underwent the DCP© intervention. Participants in the intervention were more likely to complete low-dose CT scans at 90 days. Current smokers were less likely to complete the DCP. Women were less likely to complete LDCT. This non-persuasive, high-quality shared decision-making intervention significantly increased lung cancer screening and was feasible in real-world clinical care. This intervention offers a promising model whereby patients can be supported in a decision, based on their values and beliefs while also supporting gains in lung cancer screening.
全国范围内肺癌筛查的比例约为 3%-5%，这一比例过低，需要采取包括共同决策和增加筛查在内的策略。我们在一家大型初级保健机构中对一项电话式在线决策支持工具（Decision Counseling Program©，DCP）的可行性进行了研究，该工具根据 USPSTF 筛查指南适用于符合肺癌筛查条件的患者。我们收集了人口统计学、决策冲突方面的数据，并进行了图表审核以确定筛查情况。从电子病历数据中，我们确定了 829 名符合年龄条件的当前或曾经的吸烟者。在联系到的 297 人中，有 54 人符合条件，其中 28 人被招募到研究中，20 人接受了 DCP©干预。干预组的参与者在 90 天内更有可能完成低剂量 CT 扫描。目前吸烟的人不太可能完成 DCP。女性不太可能完成 LDCT。这种非劝导性的、高质量的共同决策干预措施显著增加了肺癌筛查率，并且在实际临床护理中是可行的。这种干预为患者提供了一种有前途的模式，使他们能够根据自己的价值观和信仰来支持决策，同时也支持肺癌筛查率的提高。
