title: Patients' Attitudes Regarding Lung Cancer Screening and Decision Aids. A Survey and Focus Group Study.
abstract: Little is known about vulnerable patients' perceptions and understanding of, and preferences for, lung cancer screening decision aids.
  
  
  
  To determine, in a low-income, racially diverse population, (1) participants' experience, preferences, and reactions to web-based and paper decision aids, and (2) their understanding of harms and benefits of lung cancer screening.
  
  
  
  We enrolled outpatients at an urban county hospital in six focus group discussions that included review of a web-based and a paper-based lung-cancer screening decision aid. Participants completed surveys before and after the focus groups.
  
  
  
  Forty-five patients participated (mean age, 61 yr; 76% current smokers; 24% former smokers); 27% had not completed high school; 50% had an annual income not exceeding $15,000; 42% were nonwhite; and 96% reported chronic illness requiring at least three health care visits yearly. Comparing the proportion with correct answers on pre- and postsurveys, participants' understanding of lung cancer screening increased, particularly of the harms of screening including the potential for false positives, extra testing, and complications. However, after conclusion of the focus groups, more than 50% believed that screening lowered the chance of getting lung cancer. Five major themes emerged from qualitative analyses. Participants (1) were not aware of the purpose of lung cancer screening; (2) wanted to know about the benefits and harms; (3) believed physicians need to communicate more effectively; (4) found decision aids helpful and influential for decision-making about screening; and (5) wanted the discussion to be personalized and tailored. Participants expressed surprise that the magnitude of their lung cancer risk and benefits of screening were lower than anticipated.
  
  
  
  Vulnerable patients find lung cancer screening decision aids helpful and generally show increased knowledge after reviewing decision aids, particularly of harms. Our results can inform future implementation efforts.
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Kristina
authors.identifier: 0000-0001-9702-0371
authors.initials: K
authors.lastname: Crothers
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Kross
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Reisch
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Shahida
authors.initials: S
authors.lastname: Shahrir
authors.affiliation: 2 Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Christopher
authors.identifier: 0000-0003-0958-8122
authors.initials: C
authors.lastname: Slatore
authors.affiliation: 3 Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound, and School of Public Health, University of Washington, Seattle, Washington; and.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Zeliadt
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Triplette
authors.affiliation: 4 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
authors.forename: Rafael
authors.identifier: 0000-0002-1076-5037
authors.initials: R
authors.lastname: Meza
authors.affiliation: 1 Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014481:United States
keywords: decision support techniques; early detection of cancer; health care disparities; lung neoplasms; qualitative research