title: Development and validation of a personalized, web-based decision aid for lung cancer screening using mixed methods: a study protocol.
abstract: BACKGROUND
  The National Lung Screening Trial demonstrated that low-dose computed tomography (LDCT) screening could be an effective way to reduce lung cancer mortality. Informed decision-making in the context of lung cancer screening requires that potential screening subjects accurately recognize their own lung cancer risk, as well as the harms and benefits associated with screening, while taking into account their personal values and preferences.
  
  
  OBJECTIVE
  Our objective is to develop a Web-based decision aid in accordance with the qualifying and certification criteria in the International Patient Decision Aid Standards instrument version 4.0 that will assist patients in making informed decisions with regard to lung cancer screening.
  
  
  METHODS
  In "alpha" testing, a prototype of the decision aid was tested for usability with 10 potential screening participants in focus groups. Feedback was also sought from public health and health risk communication experts external to the study. Following that, improvements to the prototype were made accordingly, and "beta" testing was done in the form of a quasi-experimental design-a before-after study-with a group of 60 participants. Outcomes tested were knowledge, risk perception of lung cancer and lung cancer screening, decisional conflict, and acceptability of the decision aid as determined by means of a self-administered electronic survey. Focus groups of a subsample of survey participants will be conducted to gain further insight into usability issues.
  
  
  RESULTS
  Alpha testing is completed. Beta testing is currently being carried out. As of 2014 December 7, 60 participants had completed the before-after study. We expect to have results by 2015 January 31. Qualitative data collection and analysis are expected to be completed by 2015 May 31.
  
  
  CONCLUSIONS
  We hypothesize that this Web-based, interactive decision aid containing personalized, graphical, and contextual information on the benefits and harms of LDCT screening will increase knowledge, reduce decisional conflict, and improve concordance between patient preferences and the current US Preventive Services Task Force's screening guidelines.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Yan Kwan
authors.identifier: http://orcid.org/0000-0002-1612-9912
authors.initials: YK
authors.lastname: Lau
authors.forename: Tanner J
authors.identifier: http://orcid.org/0000-0002-6560-0547
authors.initials: TJ
authors.lastname: Caverly
authors.forename: Sarah T
authors.identifier: http://orcid.org/0000-0002-9000-4202
authors.initials: ST
authors.lastname: Cherng
authors.forename: Pianpian
authors.identifier: http://orcid.org/0000-0001-8886-9672
authors.initials: P
authors.lastname: Cao
authors.forename: Mindy
authors.identifier: http://orcid.org/0000-0002-6501-613X
authors.initials: M
authors.lastname: West
authors.forename: Douglas
authors.identifier: http://orcid.org/0000-0001-7707-5092
authors.initials: D
authors.lastname: Arenberg
authors.forename: Rafael
authors.identifier: http://orcid.org/0000-0002-1076-5037
authors.initials: R
authors.lastname: Meza
keywords: informed decision-making; lung cancer screening; patient decision aid; patient education