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Fukunaga MI, Halligan K, Kodela J, et al. Tools to Promote Shared Decision-Making in Lung Cancer Screening Using Low-Dose CT Scanning: A Systematic Review. Chest. 2020 Dec;158(6):2646-2657. doi: 10.1016/j.chest.2020.05.610. Epub 2020 Jul 3. (Systematic review)
Abstract

BACKGROUND: Decisions about lung cancer screening are inherently complex and create a need for methods to convey the risks and benefits of screening to patients.

RESEARCH QUESTION: What kind of decision aids or tools are available to support shared decision-making for lung cancer screening? What is the current evidence for the effectiveness, acceptability, and feasibility of those tools?

STUDY DESIGN AND METHODS: We conducted a systematic review of studies and searched PubMed, MEDLINE, EMBASE, Cochrane Clinical Trials Register, and ClinicalTrials.gov from inception to December 2019 for studies that evaluated the effectiveness and acceptability of tools to promote shared decision-making for patients who are considering lung cancer screening.

RESULTS: After screening 2,427 records, we included one randomized control trial, two observational studies, 11 before/after studies of a decision aid or an educational tool. Fifteen distinct tools in various formats were evaluated in 14 studies. Most studies were of fair quality. Studies reported improvement in patients' knowledge of lung cancer screening (n = 9 studies), but improvements in specific areas of knowledge were inconsistent. Decisional conflict was low or reduced after the administration of the tools (n = 7 studies). The acceptability of tools was rated as "high" by patients (n = 7 studies) and physicians (n = 1 study). Low dose CT scan completion rates varied among studies (n = 6 studies).

INTERPRETATION: Evidence from 14 studies suggests that some elements of existing tools for lung cancer screening may help to prepare patients for decision-making by improving knowledge and reducing decisional conflict. Such tools generally are acceptable to patients and providers. Further studies that use consistent measures and reporting methods and assess relevant decisional and clinical outcomes are needed to determine the comparative effectiveness and feasibility of implementation of these tools.

CLINICAL TRIAL REGISTRATION: PROSPERO 2018 CRD4201874814.

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Comments from MORE raters

Physician rater

This is a good review of SDM tools for lung cancer screening that is most relevant to pulmonologists, primary care providers and others who provide preventive services.

Physician rater

Lung cancer screening not part of UK healthcare at the moment. Most tools cited here haven't been developed/tested in UK populations, who will only have experienced testing rather than screening (potentially different understanding/expectation and risk/benefit ratio). There are pilot 'case finding' studies in UK at the moment but UK practitioners not currently involved in counselling patients on involvement. I don't think this is useful information at this stage.

Physician rater

The article points out the less than adequate materials for counseling patients about cancer screening. LDCT does not change overall mortality. The J Gen Intern Med 2020;35(10):3015-3025 article states the lung cancer death is decreased from 2.2% to 1.8%. A pictogram would be helpful in counseling patients.

Physician rater

This review, as the authors correctly stated, did not identify a decision aid that is ready for routine use in primary care.

Physician rater

SDM for lung cancer screening is very important (as with all screening). This review highlights what to expect with the current tools for SDM.

Physician rater

Informed decision making for patients undergoing lung cancer screening is important. This systematic review notes that more well-designed high quality studies are needed to find the decision support tools to help patients and physicians engage in discussions around lung cancer screening.
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