shared decision making; lung cancer; urban health; health disparities; cancer screening, decision aid


Bioinformatics | Community Health and Preventive Medicine | Health Communication | Oncology | Other Public Health | Preventive Medicine | Pulmonology | Respiratory Tract Diseases


Introduction: Few lung cancer screening decision aids have been tested in diverse populations. The study objective was to determine whether the online decision aid www.shouldiscreen.com impacts knowledge of and decisional conflict around lung cancer screening in a diverse population.

Methods: Eligible patients had significant smoking histories, were at increased risk for lung cancer (ages 45-80, >20 pack-years, smoking within last 15 years) and had no history of prior lung cancer or screening. Data was collected and analyzed in 2017.

Results: 40 patients were enrolled: 80% were female, 62.5% black, 33% white, and 48% had a high school education or less. 80% were current smokers with a mean of 34 pack-years accumulated. 35% were eligible for screening by U.S. Preventive Services Task Force criteria. After reviewing the decision aid, knowledge increased in all categories including risk factors for lung cancer (3.58 to 4.30, p<0.01), benefits of screening (1.58 to 2.30, p<0.01), possible harms of screening (0.93 to 2.08, p<0.01), and eligibility for screening (2.10 to 2.65, p<0.01). Decisional conflict was reduced from 21.25 to 8.65 (p<0.01). After use of the decision aid, more patients expressed a preference not to be screened for lung cancer, such that concordance with USPSTF guidelines decreased among those who were eligible to screen increased among those who did not yet meet eligibility criteria; however, this finding was not statistically significant.

Conclusions: Even brief, unguided use of this web-based tool improved knowledge and reduced decisional conflict for a diverse group of smokers considering lung cancer screening.