title: Patient-centered outcomes among lung cancer screening recipients with computed tomography: a systematic review.
abstract: BACKGROUND
  Lung cancer screening using low-dose computed tomography (LDCT) is now widely recommended for adults who are current or former heavy smokers. It is important to evaluate the impact of screening on patient-centered outcomes. Among current and former smokers eligible for lung cancer screening, we sought to determine the consequences of screening with LDCT, and subsequent results, on patient-centered outcomes such as quality of life, distress, and anxiety.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth Quarter 2012), MEDLINE (2000 to May 31, 2013), reference lists of articles, and Scopus for relevant English-language studies and systematic reviews. To evaluate the effect of LDCT screening on patient-centered outcomes, we included only randomized controlled trials (RCTs) involving asymptomatic adults. To evaluate the association of particular results and/or recommendations from a screening LDCT with patient-centered outcomes, we included results from RCTs as well as from cohort studies.
  
  
  RESULTS
  A total of 8215 abstracts were reviewed. Five publications from two European RCTs and one publication from a cohort study conducted in the United States met inclusion criteria. The process of LDCT lung cancer screening was associated with short-term psychologic discomfort in many people but did not affect distress, worry, or health-related quality of life. False-positive results were associated with short-term increases in distress that returned to levels that were similar to those among people with negative results. Negative results were associated with short-term decreases in distress.
  
  
  CONCLUSIONS
  As lung cancer screening is implemented in the general population, it will be important to evaluate its association with patient-centered outcomes. People considering lung cancer screening should be aware of the possibility of distress caused by false-positive results. Clinicians may want to consider tailoring communication strategies that can decrease the distress associated with these results.
authors.affiliation: Health Services Research and Development, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Portland VA Medical Center, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Portland, Oregon; Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon. Electronic address: slatore@ohsu.edu.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Portland, Oregon.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Sullivan
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon.
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Portland, Oregon; Division of Specialty and Hospital Medicine, Portland VA Medical Center, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Humphrey
mesh_terms: D001007:Anxiety / Q000209:etiology*; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000523:psychology*; D018802:Patient-Centered Care; D011788:Quality of Life / Q000523:psychology*; D011829:Radiation Dosage; D013315:Stress, Psychological / Q000209:etiology; D014057:Tomography, X-Ray Computed