title: What factors do patients consider most important in making lung cancer screening decisions? Findings from a demonstration project conducted in the Veterans Health Administration.
abstract: The National Lung Screening Trial recently reported that annual low-dose computed tomography screening is associated with decreased lung cancer mortality in high-risk smokers. This study sought to identify the factors patients consider important in making lung cancer screening (LCS) decisions, and explore variations by patient characteristics and LCS participation.
  
  
  
  This observational survey study evaluated the Minneapolis VA LCS Clinical Demonstration Project in which LCS-eligible Veterans (N=1388) were randomized to either Direct LCS Invitation (mailed with decision aid, N=926) or Usual Care (provider referral, N=462). We surveyed participants three months post-randomization (response rate 44%) and report the proportion of respondents rating eight decision-making factors (benefits, harms, and neutral factors) as important by condition, patient characteristics, and LCS completion.
  
  
  
  Overall, the most important factor was personal risk of lung cancer and the least important factor was health risks from LCS. The reported importance varied by patient characteristics, including smoking status, health status, and education level. Overall, the potential harms of LCS were reported less important than the benefits or the neutral decision-making factors. Exposure to Direct LCS Invitation (with decision aid) increased Veterans' attention to specific decision-making factors; compared to Usual Care respondents, a larger proportion of Direct LCS Invitation respondents rated the chance of false-positive results, LCS knowledge, LCS convenience, and anxiety as important. Those completing LCS considered screening harms less important, with the exception of incidental findings.
  
  
  
  Decision tools influence Veterans' perceptions about LCS decision-making factors. As the factors important to LCS decision making vary by patient characteristics, targeted materials for specific subgroups may be warranted. Attention should be paid to how LCS incidental findings are communicated.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA; Division of General Internal Medicine, University of Minnesota, Minneapolis, USA. Electronic address: sarah.lillie@va.gov.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lillie
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA; Division of General Internal Medicine, University of Minnesota, Minneapolis, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Fu
authors.affiliation: Division of Pulmonology, Minneapolis VA Health Care System, Minneapolis, USA.
authors.forename: Angela E
authors.initials: AE
authors.lastname: Fabbrini
authors.affiliation: Division of Pulmonology, Minneapolis VA Health Care System, Minneapolis, USA; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clothier
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA; Division of General Internal Medicine, University of Minnesota, Minneapolis, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Doro
authors.affiliation: Pulmonary and Critical Care, Wayne State University, Detroit, USA.
authors.forename: M Anas
authors.initials: MA
authors.lastname: Moughrabieh
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, USA; Division of General Internal Medicine, University of Minnesota, Minneapolis, USA.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010465:Perception; D012907:Smoking / Q000401:mortality; D000074606:Smoking Prevention; D014057:Tomography, X-Ray Computed / Q000379:methods; D058014:Veterans Health / Q000193:education* / Q000592:standards
keywords: Attitudes; Decision making; Early detection of cancer; Lung neoplasms